农村和城市食管鳞癌患者生存影响因素对比分析

胡守佳; 宋昕; 赵学科; 吕双; 程让; 陈培楠; 靳艳; 鲁建亮; 张向阳; 杜丹凤; 范宗民; 韩渭丽; 王立东

doi:10.3969/j.issn.1000-8179.2017.15.135

农村和城市食管鳞癌患者生存影响因素对比分析

Comparative analysis on survival of the patients with esophageal squamous cell carcinoma from rural and urban regions

摘要

摘要:
目的探讨农村和城市地区差异对食管鳞癌患者生存影响。
方法 36 723例食管鳞癌患者临床诊疗、病理和随访信息全部取自郑州大学第一附属医院河南省食管癌重点开放实验室50万例食管癌和贲门癌生物样本数据库（1973年至2015年）。农村患者33 625例（91.6%），其中男性20 906例，平均诊断年龄（58.98±8.71）岁；女性12 719例，平均诊断年龄（59.59±8.53）岁；城市患者3 098例（8.4%），其中男性2 089例，平均诊断年龄（60.84±9.10）岁；女性1 009例，平均诊断年龄（62.46±9.14）岁。所有患者均行食管癌根治术治疗，并记录完整病理TNM分期。采用χ²检验、Kaplan-Meier，Log-rank和多因素Cox风险比例回归模型方法分析各组间差异及生存影响因素。
结果 Kaplan-Meier和Log-rank总体分析显示：农村食管癌患者整体生存明显优于城市患者（χ²=12.971，P < 0.001）；年龄、性别和TNM分期多因素分层分析显示：农村年龄≥50岁男性和女性Ⅱa、Ⅱb（中期）的患者生存明显优于城市患者（男性：χ²=16.188，P < 0.001；女性：χ²=5.019，P=0.025）；但是，0、Ⅰa、Ⅰb（早期）和Ⅲa、Ⅲc、Ⅳ期（晚期）农村和城市患者生存差异无统计学意义（P＞0.05）。Cox比例风险回归模型分析显示：影响农村和城市患者生存的独立危险因素均为年龄、性别和TNM分期；而农村和城市患者综合分析显示：男性、诊断年龄≥50岁、城市和TNM分期是食管鳞癌患者预后差的独立危险因素。
结论农村地区食管癌患者整体生存优于城市患者；男性、诊断年龄≥50岁、城市和TNM分期是食管鳞癌患者预后差的独立危险因素。

Abstract:
Objective To elucidate the factors influencing the differences in the survival rates of esophageal squamous cell carcinoma (ESCC) patients between the rural and urban regions in China.
Methods A total of 36, 723 ESCC patients derived from the clinical databases containing 500, 000 esophageal and gastric cardia carcinoma cases (1973-2015) of the Henan Key Laboratory for Esophageal Cancer Research of the First Affiliated Hospital, Zhengzhou University, were analyzed. Of these patients, 33, 625 were from the rural regions (91.6%), comprising 20, 906 male patients with an average age of 58.98±8.71 years and 12, 719 females with an average age of 59.59±8.53 years. The remaining 3, 098 were from the urban regions and composed of 2, 089 male patients with an average age of 60.84±9.10 years and 1, 009 females with an average age of 62.46 ± 9.14 years. All the patients underwent radical esophagectomy, detailed histopathological diagnosis, and TNM staging. Chi square test, Kaplan-Meier, Log-rank, and Cox proportional hazards regression model were used to analyze the differences between ESCC patients from rural regions and those from urban regions and among the risk factors in prognosis.
Results Kaplan-Meier and Log-rank analysis results showed that the ESCC patients from the rural regions had significantly higher overall survival than the urban patients (χ²=12.971, P=0.000). Further analysis showed that rural patients ≥50 years old and diagnosed with stage Ⅱa and Ⅱb (middle stage) ESCC had higher survival rates than urban patients in males and females (male: χ²=16.188, P < 0.001; female: χ²=5.019, P=0.025). However, the survival rates of rural and urban patients with stage 0, Ⅰa, Ⅰb (early stage) and Ⅲ a, Ⅲ c, and Ⅳ (late stage) were similar (P > 0.05). The results of Cox proportional hazards regression model analysis showed that age, gender, and TNM stages were independent risk factors for rural and urban ESCC patients. When the rural and urban ESCC patients were both considered, the Cox proportional hazards regression model analysis results showed that male ESCC patients ≥ 50 years old, urban residence, and TNM stages were independent risk factors.
Conclusion Rural ESCC patients have significantly higher overall survival than urban patients. Male, age of ≥50 years old, urban residence, and TNM stages were independent risk factors for ESCC patient survival.

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