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基于SEER数据库分析手术治疗和内镜切除治疗表浅食管鳞癌的长期疗效

Analysis of the long-term efficacy of surgical treatment and endoscopic resection for superficial esophageal squamous cell carcinoma based on the SEER database

    摘要
  • 摘要:
    目的 基于SEER数据库分析Tis及T1期食管鳞癌患者接受手术或内镜治疗后的生存情况，以期为食管癌的早期治疗提供参考。
    方法 从美国SEER数据库获取2004年至2012年初次病理确诊为食管鳞癌的病例，均有完整T及N分期信息、无远处转移、预后和随访信息完整、肿瘤原发灶治疗信息完整。主要结局为食管癌特异性死亡。用Cox回归模型分析患者食管癌特异性死亡影响因素。
    结果 共纳入337例患者，其中158例（46.88%）接受外科手术（手术组），165例（48.96%）接受内镜局部切除（有病理标本送检，内镜切除组），14例（4.15%）接受内镜局部毁损（无病理标本送检，内镜毁损组）。手术组及内镜切除组患者纳入生存分析，随访2~105个月，中位随访32个月，两组中位生存时间均未达到。Kaplan-Meier生存曲线显示，内镜切除组食管癌特异性死亡率为4.24%（7/165），手术组食管癌特异性死亡率为22.78%（36/158）。单因素Cox回归分析显示，与外科手术相比，内镜局部切除治疗患者食管癌特异性死亡风险为0.21（95% CI 0.09~0.46，P < 0.001）；多因素Cox回归显示，内镜局部切除治疗是减少患者食管癌特异性死亡的独立保护因素（HR=0.34（95% CI 0.14~0.83，P=0.017）。分别剔除淋巴结阳性、随访时间短于6个月及Tis期患者后，内镜局部切除治疗仍是减少患者食管癌特异性死亡的独立保护因素（P < 0.05）。
    结论 对于Tis及T1期食管鳞癌患者，内镜局部切除的长期疗效优于外科手术，接受内镜局部切除患者的食管癌特异性死亡风险降低。

     

    Abstract:
    Objective To analyze the long-term efficiency of endoscopic treatment and surgical resection in patients with Tis and T1 esophageal squamous cell carcinoma based on SEER database, and to provide evidence for early treatment of esophageal cancer.
    Methods The newly diagnosed and pathologically confirmed esophageal squamous cell carcinoma cases with complete T and N staging information, without metastasis, with complete prognosis, follow-up, and treatment information of primary site originated from SEER database of the United States were acquired from 2004 to 2012. The main outcome was esophageal cancer specific mortality. Cox regression was used in factor analyses of esophageal cancer specific mortality.
    Results A total of 337 patients were included, among whom, 158 (46.88%) underwent surgery, 165 (48.96%) underwent local endoscopic resection (with pathological specimen), and 14 (4.15%) underwent local endoscopic destruction (without pathological specimen). 158 patients in surgery group and 165 patients in endoscopic resection group were included in survival analysis, with a follow-up time of 2-105 months and a median follow-up time of 32 months. Median survival time of patients in the surgery and endoscopic resection groups was not reached. Kaplan-Meier survival curves indicated that the esophageal cancer specific mortality were 4.24% (7/165) and 22.78% (36/158) in endoscopic resection and surgery groups, respectively. Univariate Cox regression revealed that the hazard ratio (HR) endoscopic resection was 0.21 compared to surgery (95%CI 0.09-0.46, P < 0.001), and multivariate Cox regression showed that endoscopic resection was independently protective factor for patients freed from the esophageal cancer specific mortality (HR=0.34, 95%CI 0.14-0.83, P=0.017). After patients with lymph node involvement, follow-up of shorter than 6 months, or stage Tis were excluded, endoscopic resection was also independently protective factor of patients (P < 0.05).
    Conclusion For the patients with Tis and T1 esophageal squamous cell carcinoma, long-term efficiency of local endoscopic resection was better than the surgery, and esophageal cancer specific mortality of patients underwent endoscopic resection could decrease.

     

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