手术切除淋巴结数和转移淋巴结数对食管鳞状细胞癌患者生存期的影响

摘要

目的:探讨食管癌手术切除淋巴结数和转移数对生存期的影响.方法:通过问卷调查和(或)电话随访,收集1976年至2002年来自于食管癌高发区、单纯行手术治疗的食管鳞状细胞癌患者的淋巴结切除数量、转移数及生存状况资料,随访共1 573例,随访期均超过10 a,评估淋巴结切除数量和转移数量对预后的影响.结果:将1 573例按淋巴结切除数1~6、7~12、≥13枚分组,3组的Kaplan-Meier生存曲线差异有统计学意义(χ2=15.379,P＜0.001);将1 573例按淋巴结转移数0、1~2、3~6、≥7枚分组,4组Kaplan-Meier生存曲线差异亦有统计学意义(χ2=180.182,P＜0.001).Cox回归模型分析结果显示,在校正了性别、浸润深度、分化程度等因素后,淋巴结切除数量增加仍是预后的保护性因素,淋巴结转移数量增加则会明显降低生存期(P＜0.001).结论:淋巴结转移数量增加是食管鳞状细胞癌患者预后差的主要因素,术中淋巴结切除数量增加是改善预后的主要因素.%Aim:To investigate the influences of the number of surgically resected lymph nodes ( LNs-r ) and the number of metastatic lymph nodes( LNs-m ) on survival of the postoperative patients with esophageal squamous cell carcinoma ( ESCC ). Methods:The questionnaire, home interview and/or telephone follow-up and hospital pathology verification were performed on 1 573 ESCC patients from ESCC high-incidence area and treated with surgery alone during 1976 ~2002. All the patients were followed up for more than 10 years. Results:Significant differences in the survival curve based on Kaplan-Meier method were found among the patients with 1 ~ 6,7 ~ 12 , and ≥ 13 LNs-r( X2 = 15. 379 ,P < 0. 001 ) and among the patients with 0,1 ~2,3 ~6, and ≥7 LNs-m(X2 = 180. 182,P <0.001 ). The results of Cox regression analysis modelrnshowed that the patients with more LNs-r number or less LNs-m number would get longer survival time( P < 0.001 ). Con-Clusion:Increase in LNs-r number was benefit, while increase in LNs-m number was risk for the prognosis of ESCC.