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[目的]分析导致食管鳞癌患者手术后早期死亡的危险因素。[方法]回顾性分析确诊为食管鳞癌并行根治性手术切除的249例患者的临床资料,随访5年。采用χ2或Fisher精确概率法、t检验等分析所有可能导致患者在术后1年内死亡的因素。单因素及多因素Cox回归模型分析确定影响患者早期死亡最主要的危险因素,使用Kaplan-Meier法中的log-rank法对患者生存率进行统计学分析。[结果]249例中39例在术后1年内死亡(早期死亡组),其肿瘤的长度、浸润深度、淋巴结转移、TNM分期、淋巴结转移区域等与非早期死亡组相比差异有统计学意义(χ2=12.688、12.042、16.202、6.685、15.654,均P<0.05)。行多因素分析发现发现肿瘤的长度≥4cm及淋巴结转移区域≥2个时是导致患者早期死亡最主要的危险因素(OR=2.305、4.370,95%CI:1.090~4.876、1.510~12.653,均P<0.05)。根据这2个主要危险因素进行生存率分析,发现有0个、1个、2个危险因素的患者的1年生存率分别为90.5%、78.2%、46.1%。Log-rank统计学方法分析显示0个、1个、2个危险因素之间差异具有统计学意义(χ2=9.377、29.019、5.981,均P<0.05)。[结论]导致食管鳞癌患者早期死亡的最主要因素是肿瘤长度及淋巴结转移,因此对于存在肿瘤的长度≥4cm及淋巴结转移区域≥2个危险因素的患者,术后有必要进行其他干预治疗如辅助放化疗等,以尽可能延长患者的生存时间。
[Objective] To analyze the risk factors of early death after operation in esophageal squamous cell carcinoma patients. [Methods] The clinical data of 249 patients with concurrent esophageal squamous cell carcinoma diagnosed as esophageal squamous cell carcinoma were retrospectively analyzed, and were followed up for 5 years. Χ2 or Fisher exact test, t-test and other factors were used to analyze all the possible causes of death in patients within 1 year after surgery. Univariate and multivariate Cox regression models were used to identify the most important risk factors affecting early death in patients. The Kaplan-Meier log-rank method was used to analyze the patients’ survival rates. [Results] 39 of 249 patients died within 1 year after operation (early death group). The length of tumor, depth of invasion, lymph node metastasis, TNM stage and lymph node metastasis were significantly different from non-early death group (χ2 = 12.688,12.042,16.202,6.685,15.654, all P <0.05). Multivariate analysis found that the length of tumor ≥ 4cm and lymph node metastasis ≥ 2 were the most important risk factors leading to early death in patients (OR = 2.305,4.370,95% CI: 1.090 ~ 4.876,1.510 ~ 12.653, P <0.05). Survival analysis of these two major risk factors showed that the 1-year survival rates of patients with 0, 1 and 2 risk factors were 90.5%, 78.2% and 46.1%, respectively. Log-rank statistical analysis showed that 0, 1 and 2 risk factors were statistically significant (χ2 = 9.377,29.019,5.981, both P <0.05). [Conclusion] The most important factor leading to the early death of patients with esophageal squamous cell carcinoma is the length of the tumor and lymph node metastasis, so for patients with tumor length> 4 cm and lymph node metastasis> 2 risk factors, other interventions such as Adjuvant radiotherapy and chemotherapy, etc., in order to extend the patient’s survival time as much as possible.