食管癌术后淋巴结状态对术后辅助治疗选择的预测价值

Predictive value of postoperative lymph node status for adjuvant therapy in esophageal cancer patients after radical resection

    摘要
  • 摘要:
      目的  分析食管癌患者术后的淋巴结状态对术后辅助治疗方案选择的预测价值及与预后的关系。
      方法  分析2007年1月至2010年12月河北医科大学第四医院354例食管癌根治术后患者，对其淋巴结各相关参数与术后辅助治疗进行预后分析。单因素生存分析采用Kaplan-Meier法和Log-rank检验，多因素生存分析采用Cox回归模型。
      结果  全组患者1、3、5年生存率分别为84.46%、64.12%和54.06%，中位生存期为86.49个月。N0、N1、N2、N3期患者的5年生存率分别为93.13%、55.50%、19.80%和3.45%，不同N分期之间的差异具有统计学意义（χ2=225.161，P < 0.001）。通过ROC曲线获取阳性淋巴结数目与清扫总淋巴结数目的比值（LNR）为分组界值8.51%将其分为两组并进行生存分析，LNR≤8.51%组及LNR>8.51%组患者的5年生存率分别为81.63%和23.40%，两组之间的差异具有统计学意义（χ2=143.504，P < 0.001）。单因素预后分析显示术后T分期、N分期、LNR、阴性淋巴结数目与患者的生存预后均相关（均P < 0.05）。多因素预后分析显示术后N分期、LNR为生存预后的独立影响因素（均P < 0.05）。N2组及LNR>8.51%组接受术后辅助治疗的患者生存显著优于单纯手术组（χ2=12.609，P < 0.001；χ2=13.171，P < 0.001）。联合N分期及LNR进行分析，在LNR>8.51%组的N2期患者接受术后辅助治疗组生存显著优于单纯手术组（χ2=12.609，P < 0.001）。
      结论  LNR可以协同N分期更好地提示预后并指导食管癌根治术后患者辅助治疗的选择。对N2期同时伴有高LNR的患者应该积极选择术后辅助治疗。

     

    Abstract:
      Objective  To analyze the predictive value of postoperative lymph node status for adjuvant therapy in esophageal cancer patients after radical resection.
      Methods  The indexes related to postoperative lymph node of 354 patients with esophageal carcinoma, who underwent radical surgery during a period between January 2007 and December 2010, were retrospectively analyzed. Univariate analysis was performed by Log-rank test and multivariate analysis by a Cox regression model.
      Results  The 1-, 3-and 5-year overall survival (OS) rates were 84.46%, 64.12% and 54.06%, respectively, and the median survival time was 86.49 months. The 5-year OS rate of N0, N1, N2 and N3 stage patients were 93.13%, 55.50%, 19.80% and 3.45%, respectively. And it is obviously different from each other in PN stage (χ2=225.161, P < 0.001). We used the cut-off value of LNR 8.51% which was obtained by ROC curve to divide the patients into two groups. The 5-year survival rates of the group with LNR ≤ 8.51% and the group with LNR>8.51% were 81.63% and 23.40%, respectively. There were significant differences between the two groups (χ2=143.504, P < 0.001). The results of univariate analysis showed that PT stage, PN stage, LNR and number of negative lymph nodes were significantly correlated with OS (all P < 0.05). Multivariate analysis showed that the PN stage and LNR were independent factors for OS (all P < 0.05). The patients in the PN2 and LNR >8.51% groups with adjuvant therapy showed a significantly better survival than those with surgery alone and without adjuvant therapy (χ2=12.609, P < 0.001; χ2=13.171, P < 0.001). The patients in the group with PN2 stage as well as LNR >8.51% who had undergone adjuvant therapy showed a significantly better survival than those with simple surgery and without adjuvant therapy (χ2=12.609, P < 0.001).
      Conclusions  The combination of PN stage and LNR as a better factor for predicting the prognosis of patients with esophageal cancer after radical resection can predict the value of adjuvant therapy. The patients with PN2 stage and higher LNR should choose postoperative adjuvant therapy.

     

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