高、低发区食管癌患者淋巴结转移及其影响因素与生存期的关系

doi:10.3971/j.issn.1000-8578.2014.03.006

高、低发区食管癌患者淋巴结转移及其影响因素与生存期的关系

Impact of Lymph Node Metastasis and Relevant Risk Factors on Survival of Patients with Esophageal Carcinoma from High- and low-incidence Areas

摘要

摘要: 目的探讨高、低发区食管癌患者淋巴结转移影响因素及其对生存期的影响，并对新版食管癌TNM分期进行评价。方法通过入户或电话问卷调查进行生存随访，采用卡方检验、二元Logistic回归，Kaplan-Meier生存曲线和Log rank检验及Cox生存分析模型，分析高、低发区食管癌患者淋巴结转移影响因素及与生存期的关系。结果淋巴结转移阳性食管癌患者（n=5 621）的生存期明显低于转移阴性患者（n=7 945）（P=1.9E-162），N1、N2和N3级食管癌患者生存期依次明显降低（P=4.2E-20）。在淋巴结转移阳性率上，高发区患者明显高于低发区（P=1.4E-5），但生存期却优于低发区（P=1.7E-39）；青年食管癌患者（≤50岁）略高于中老年患者（＞50岁）（P=0.003），而生存期显著优于中老年患者（P=2.3E-31）；下段食管癌显著高于中段和上段（P=8.6E-24），而生存期则明显优于中段和上段（P=0.03）。多因素分析，高低发区、性别、诊断年龄、肿瘤部位、分化和浸润程度是影响食管癌患者淋巴结转移和生存期的独立因素，N1、N2和N3级患者生存期差的风险值依次升高（HRN1=1.8，HRN2=2.5，HRN3=2.7）。结论淋巴结转移阳性患者生存期显著差于转移阴性的患者；随着淋巴结转移个数增多，食管癌患者生存期明显降低；高发区患者整体生存期优于低发区患者。

Abstract: Objective To investigate the effects of lymph node metastasis(LNM) and relevant factors on survival of the patients with EC from the high- and low-incidence areas,and to evaluate the new TNM staging. Methods The questionnaire, home interview and/or telephone were performed for survival followup on EC patients. The Chi-square test, Logistic regression, Kaplan-Meier survival analysis, Log rank test and multivariate Cox regression model were applied to assess the impacts of LNM on survival of patients. Results The survival time of LNM negative patients (n=7 945) was significantly longer than that of LNM positive patients (n=5 621) (P=1.9E-162). The survival time in N1, N2 and N3 patients with EC was gradually reduced (P=4.2E-20). The positive rate of LNM in HIA patients was signifi cantly higher than that in LIA patients (P=1.4E-5),however the survival time in HIA patients was signifi cantly longer than that in LIA patients (P=1.7E-39).The positive rate of LNM in younger patients (≤50 years) was slightly higher than that in elderly patients (>50 years) (P=0.003), while the survival time in younger patients (≤50 years) was signifi cantly longer than that in elderly patients (>50 years) (P=2.3E-31); the positive rate of LNM in lower segment EC patients was signifi cantly higher than that in the middle and upper segments EC patients (P=8.6E-24),while the survival time of LNM in lower segment EC patients was signifi cantly longer than that in the middle and upper segments EC patients (P=0.03). Multivariate regression analysis showed that HIA and LIA, gender, age at diagnosis, tumor location, differentiation, and invasion were independent factors for LNM and survival of patients with EC. The risk of poor prognosis was successively increased in N1, N2 and N3 patients with EC (HRN1=1.8, HRN2=2.5, HRN3=2.7). Conclusion The survival time of LNM positive patients was signifi cantly lower than that of LNM negative patients. With the number of LNM increased, survival time of patients was signifi cantly decreased. Patients in HIA, younger and lower segment had signifi cantly higher positive rates of LNM,but shorter overall survival than those in LIA, elderly, middle and upper segment EC patients.

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