中晚期食管癌肿瘤大体类型生物学特征及其对生存期的影响

摘要

Objective The present study aimed to compare the gross biological characteristics of tumor from patients of the four kinds of esophageal cancer at middle and advanced stage and the influence on the survival in order to further shed light on the key prognostic factors for EC . Methods The questionnaire , home interview and/or telephone interview were performed for survival follow-up on ESCC patients , and check the clinical information of ESCC patients in hospitals . The Chi square test , Kaplan-Meier survival analysis , Log-rank test and multivariate Cox regression model were applied to the comparison . Results The followup was successfully made in 9672 cases (92 .9% ) . The survival time in patients of fungating type was significantly longer than that in patients with medullary , ulcerating , and constriction types (P<0 .005 ) . The constituent ratio for four kinds of gross tumor types at middle and advanced stages was significantly different respectively in high and low incidence areas , male and female gender , youth ( ≤50) and older ( > 50) patients (P<0 .05 ) .The constituent ratio for four kinds of gross tumor types at middle and advanced stages was significantly different respectively in tumor location ( upper , middle and lower segment) , tumor differentiation , number of positive lymph nodes , and tumor invasion (P<0 .05 ) . It was noteworthy that the ratio of fungating type patients with well differentiation was higher than that of other three types , but the ratio with two or more positive lymph nodes and at T 3 + T4-stage was less than those of the other three types . Multivariate regression analysis showed that , tumor gross types was not independent factors for survival of patients with EC at middle and advanced stage . Conclusion The ratio of fungating type patients with well differentiation was higher than that of other three types , but , the ratio with two or more positive lymph nodes and at T3 + T4 stage was less than those of the other three types . The survival of fungating type patients was the best . Tumor gross type was not independent factors for survival of patients with advanced EC .%目的通过比较中晚期食管癌四种大体类型的生物学特征，探讨食管癌大体类型对患者生存期的影响，加深对食管癌关键预后影响因素的了解。方法采用入户/电话进行问卷调查及生存随访，医院核查食管癌患者信息，采用卡方检验、Kaplan-Meier生存曲线，Log-Rank检验和Cox生存分析模型，分析中晚期食管癌肿瘤大体类型特征及其对患者生存期的影响。结果成功随访9672例患者（929．％）。蕈伞型患者生存期明显优于髓质型、溃疡型和缩窄型患者（ P＜00．5）。中晚期食管癌四种大体类型在高低发区、性别、青年（≤50岁）和中老年（＞50岁）患者中的构成比明显不同（P ＜00．5）。在肿瘤部位（上、中和下段）、分化程度、阳性淋巴结转移个数和浸润程度上四种大体类型的构成亦明显不同（P ＜00．5），值得指出的是，蕈伞型高分化所占比例高于其他三型，阳性转移淋巴结两个以上的患者少于其他三型，T3＋ T4级患者所占比例明显底于其他三型。COX多因素分析肿瘤大体类型不是影响中晚期食管癌患者生存期的独立因素。结论蕈伞型高分化癌的比例高于髓质型、溃疡型和缩窄型患者，而在阳性转移淋巴结两个以上和T3＋ T4级患者所占比例低于以上三型，生存期最优；中晚期食管癌大体类型不是影响患者生存期的独立因素。