基于SEER数据库食管癌病理特征及预后分析
Pathological Characteristics and Prognosis of Esophageal Cancer Based on SEER Database
DOI: 10.12677/ACM.2020.107226, PDF,    国家科技经费支持
作者: 张云波, 郑丽萍, 张建光：淄博岜山万杰医院肿瘤科，山东 淄博；李 敬：淄博岜山万杰医院内科，山东 淄博；刘俊启：郑州大学第一附属医院放疗科，河南 郑州；李锦秋：河北北方学院第一附属医院放疗科，河北 张家口；于会明：北京肿瘤医院放疗科，北京；杨彩霞：齐鲁医药学院，山东 淄博
关键词: 食管鳞状细胞癌；食管腺癌；预后；Squamous Cell Carcinoma of the Esophagus； Adenocarcinoma of the Esophagus； Prognosis
摘要: 目的：探讨食管鳞状细胞癌(SCC, squamous cell carcinoma)和食管腺癌(AC, adenocarcinoma)患者的预后及性别、年龄、人种、婚姻状况、分化程度、分期、肿瘤位置和治疗措施对预后的影响。方法：搜索SEER数据库2010年~2015年病理诊断明确的食管鳞癌和腺癌患者，共计12,872例。统计患者2年、3年、5年总生存率。Kaplan-Meier (K-M)法计算生存率，Log-rank法检验和单因素分析，Cox回归进行多因素分析。结果：两组单因素分析性别、年龄、人种、婚姻、分化程度、分期及治疗方式为预后影响因素。多因素Cox回归模型分析显示，SCC组中性别(HR: 1.241, 95% CI: 1.150~1.338, P < 0.001)、人种(HR: 0.928, 95% CI: 0.861~1.000, P = 0.048)、婚姻(HR: 0.882, 95% CI: 0.820~0.948, P = 0.001)、分化程度(HR: 0.901, 95% CI: 0.873~0.971, P = 0.006)、T分期(HR: 0.912, 95% CI: 0.833~1.000, P = 0.049)、M分期(HR: 0.680, 95% CI: 0.611~0.756, P < 0.001)、临床分期(HR: 0.702, 95% CI: 0.620~0.794, P < 0.001)、手术(HR: 3.158, 95% CI: 2.819~3.537, P < 0.001)、化疗(HR: 2.182, 95% CI: 1.996~2.385, P < 0.001)和放疗(HR: 1.624, 95% CI: 1.481~1.781, P < 0.001)为预后影响因素；AC组中性别(HR: 1.102, 95% CI: 1.020~1.190, P = 0.014)、年龄(HR: 0.870, 95% CI: 0.824~0.918, P < 0.001)、婚姻(HR: 0867, 95% CI: 0.822~0.914, P < 0.001)、分化程度(HR: 0.817, 95% CI: 0.774~0.861, P < 0.001)、T分期(HR: 0.883, 95% CI: 0.826~0.945, P < 0.001)、M分期(HR: 0.605, 95% CI: 0.562~0.652, P < 0.001)、临床分期(HR: 0.677, 95% CI: 0.614~0.746, P < 0.001)、手术(HR: 3.256, 95% CI: 3.046~3.481, P < 0.001)、化疗(HR: 1.903, 95% CI: 1.775~2.040, P < 0.001)和放疗(HR: 0.887, 95% CI: 0.832~0.945, P < 0.001)为预后影响因素。SCC组和AC组2年总生存率分别为32.9%和40.4% (P < 0.001)，3年总生存率分别为26.6%和31.7% (P < 0.001)，5年总生存率分别为18.9%和23.6% (P < 0.001)。结论：SCC与AC的预后因素存在差异。SCC总生存率明显差于AC。
Abstract: Objective: To explore the prognosis of patients with esophageal squamous cell carcinoma and adenocarcinoma, and the influence of gender, age, race, marital status, degree of differentiation, stage, tumor location and treatment mode. Methods: Searching SEER database from 2010 to 2015, a total of 12872 patients with esophagus squamous cell carcinoma and adenocarcinoma were diagnosed pathologically. The 2-year, 3-year and 5-year overall survival rates were calculated. Prognosis factors were evaluated. Kaplan-Meier (K-M) method was used to calculate the survival rate, log rank test and univariate analysis. Cox regression was used for multivariate analysis. Results: Univariate analysis of the two groups showed that gender, age, race, marital status, degree of differentiation, stage and mode of treatment were all prognostic factors. Multivariate Cox regression analysis showed that gender (HR: 1.241, 95% CI: 1.150 - 1.338, P < 0.001), race (HR: 0.928, 95% CI: 0.861 - 1.000, P = 0.048), marital status (HR: 0.882, 95% CI: 0.820 - 0.948, P = 0.001), degree of differentiation (HR: 0.901, 95% CI: 0.873 - 0.971, P = 0.006), T stage (HR: 0.912, 95% CI: 0.883 - 1.000, P = 0.049), M stage (HR: 0.680, 95% CI: 0.611 - 0.756, P < 0.001), stage (HR: 0.702, 95% CI: 0.620 - 0.794, P < 0.001), operation (HR: 3.158, 95% CI: 2.819 - 3.537, P < 0.001), chemotherapy (HR: 2.182, 95% CI: 1.996 - 2.385, P < 0.001) and radiotherapy (HR: 1.624, 95% CI: 1.481 - 1.781, P < 0.001) in SCC group were the prognostic factors, while the gender (HR: 1.102, 95% CI: 1.020 - 1.190, P = 0.014), age (HR: 0.870, 95% CI: 0.824 - 0.918, P < 0.001), marital status (HR: 0867, 95% CI: 0.822 - 0.914, P < 0.001), degree of differentiation (HR: 0.817, 95% CI: 0.774 - 0.861, P < 0.001), T stage (HR: 0.883, 95% CI: 0.826 - 0.945, P < 0.001), M stage (HR: 0.605, 95% CI: 0.562 - 0.652, P < 0.001), stage (HR: 0.677, 95% CI: 0.614 - 0.746, P < 0.001), operation (HR: 3.256, 95% CI: 3.046 - 3.481, P < 0.001), chemotherapy (HR: 1.903, 95% CI: 1.775 - 2.040, P < 0.001) and radiotherapy (HR: 0.887, 95% CI: 0.832 - 0.945, P < 0.001) were prognostic factors of AC. The 2-year overall survival rates of SCC group and AC group were 32.9% and 40.4%, respectively (P < 0.001). The 3-year overall survival rates of SCC group and AC group were 26.6% and 31.7%, respectively (P < 0.001). The 5-year overall survival rates of SCC group and AC group were 18.9% and 23.6%, respectively (P < 0.001). Conclusion: The prognostic factors of SCC group were different from those of AC group. The prognosis of SCC is worse than that of AC.
文章引用：张云波, 李敬, 刘俊启, 郑丽萍, 李锦秋, 于会明, 张建光, 杨彩霞. 基于SEER数据库食管癌病理特征及预后分析[J]. 临床医学进展, 2020, 10(7): 1500-1510. https://doi.org/10.12677/ACM.2020.107226

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