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Ivor Lewis手术治疗食管鳞癌的临床效果及预后影响因素分析 被引量:2

Analysis of outcomes and prognostic factors after Ivor Lewis esophagectomy
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摘要 目的探讨 Ivor Lewis 食管癌根治术治疗食管鳞癌的临床效果、预后影响因素以及对 N 分期的影响。方法回顾性分析2004年1月至2013年12月1145例 Ivor-Lewis 食管鳞癌切除患者的临床资料,分析食管癌手术治疗方法及性别、年龄、肿瘤部位、肿瘤长度、浸润深度、分化程度、脉管瘤栓、神经累及、病理分期、淋巴结转移情况、术后治疗等指标,采用 Kaplan-Meier 法进行生存分析及 Cox 回归分析。结果术后并发症发生率9.15%,围手术期死亡率1.83%,总体1、3、5年生存率分别为84.2%、58.4%、47.9%,中位生存时间55个月,全组平均生存时间为(70.16±2.08)个月;单因素 Cox 分析显示,性别(P =0.003)、吸烟史(P =0.013)、饮酒史(P =0.017)、肿瘤部位(P =0.001)、体质量指数(P =0.008)、肿瘤长度(P =0.000)、肿瘤分化程度(P =0.000)、淋巴结转移(P =0.000)、淋巴结转移区域数(P =0.000)、淋巴结转移度(P =0.000)、浸润深度(P =0.000)、病理分期(P =0.000)、脉管瘤栓(P =0.000)、神经累及(P =0.000)及术后辅助治疗(P =0.000)等是术后生存的显著影响因素(P <0.05),而年龄与患者预后无明显显著关系(P >0.05);多因素 Cox分析显示,肿瘤分化程度(P =0.000)、淋巴结转移分期(P =0.000)、淋巴结转移区域数(P =0.013)及肿瘤浸润深度(P =0.000)是患者预后的重要独立危险因素。结论Ivor Lewis 食管癌手术是安全有效的治疗方式,肿瘤的分化程度、浸润深度以及淋巴结转移是重要的预后影响因素。 Objective To explore the outcomes and prognostic effects of Ivor Lewis esophagectomy and evalue the N staging.Methods Participants comprised 1145 patients with ESCC from Jan.2004 to Dec.2013,who under-went Ivor Lewis esophagectomy.The clinicopathologic data were analyzed.Kaplan -Meier and Cox regression methods were used for survival analysis.Results The morbidity of postoperative complication was 9.15% and with 1.83% of motality.The 1 -,3 - and 5 -year survival rates were 84.2%,58.4%,47.9% respectively.The median survival time was 55 months and average survival time was (70.16 ±2.086)months.Cox model multivariate analysis was used for those of P 〈0.05 in single variate analysis.Univariate analysis revealed that gender(P =0.003),smoking history (P =0.013),alcohol history(P =0.017),tumor location(P =0.001),body mass index(P =0.008),tumor length (P =0.000),differentiation degree(P =0.000),numbers of metastic zones(P =0.000)of lymph node metastasis (P =0.000),depth of invasion (P =0.000),pathological staging(P =0.000),vascular tumor thrombus (P =0.000),nerve involvement(P =0.000)and postoperative adjuvant therapy(P =0.000)were influencing prognosis factors.And multivariate analysis revealed that differentiation degree(P =0.000),depth of invasion(P =0.000), numbers of metastic zones (P =0.013 )of lymph node metastasis (P =0.000)were independent risk factors. Conclusion Ivor Lewis esophagectomy was a safe and effective treatment,and tumor differentiation degree,depth of invasion,numbers and zones of lymph node metastasis were important prognostic factors.
作者 陶开义 周鑫明 陈奇勋 蒋友华 刘金石 赵强 Tao Kaiyi, Zhou Xinming, Chert Qixun ,Jiang Youhua ,Liu Jinshi ,Zhao Qiang.(Department of Thoracic Surgery, Zhejiang Cancer Hospital, Hangzhou , Zhejiang 310022, China)
出处 《中国基层医药》 CAS 2016年第12期1878-1884,I0001共8页 Chinese Journal of Primary Medicine and Pharmacy
关键词 Ivor Lewis术 食管肿瘤 预后 因素分析 统计学 Ivor Lewis Esophageal neoplasms Prognosis Factor analysis, statistical
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