Prognostic factors for the survival of patients with esophageal carcinoma in the US - The importance of tumor length and lymph node status
Prognostic factors for the survival of patients with esophageal carcinoma in the US - The importance of tumor length and lymph node status
复制标题
DOI：
10.1002/cncr.10868
复制
发表时间：
2002-10-01
期刊：
影响因子：
6.2
通讯作者：
Wilcox, CM
中科院分区：
文献类型：
--
作者：
Eloubeidi, MA;Desmond, R;Wilcox, CM
背景目前的TNM分期系统在食管癌患者的分期和分类方案中没有考虑肿瘤长度或淋巴结数量。利用美国国家癌症研究所SEER项目的数据，作者探讨了肿瘤长度和阳性淋巴结数量对食管癌患者生存率的影响。食管腺癌或鳞状细胞癌患者根据病史分期分为局限性、区域性或远处疾病。对人口统计学因素（诊断时的年龄、种族和性别）和肿瘤特征（形态学、组织学分级、肿瘤长度、原发部位、浸润深度、阳性淋巴结数量、阳性淋巴结清扫比例和远处转移部位）进行了检查。与死亡风险增加相关的总体因素包括诊断时年龄增加、黑人与白色人种、组织学分级、原发肿瘤部位在食管下部和腹部与上部以及浸润深度增加。在有局部病变的患者中，阳性淋巴结数量（大于或等于5 vs.< 5）与风险增加相关（风险比[HR]，1.29; 95%置信区间[95%CI]，1.06-1.56）。阳性淋巴结的比例与清扫的淋巴结数量相比，风险增加（HR，1.63; 95%.CI，1.26-2.11）。在远处病变患者中，远处淋巴结以外的部位提示死亡风险增加（HR，1.37; 95%CI，1.37-1.65）。在控制肿瘤浸润深度的情况下，肿瘤长度是一个独立的死亡预测因子（HR，1.15; 95%CI，1.08-1.21）。肿瘤长度、受累淋巴结数目和阳性淋巴结比例是影响食管癌患者生存率的重要预后因素。在食管癌TNM分期中，肿瘤长度和阳性淋巴结数目可作为两个重要的预后因素。
BACKGROUND. The current TNM classification system does not consider tumor length or the number of lymph nodes in the staging and classification scheme for patients with esophageal carcinoma. Using data from the National Cancer Institute SEER Program, the authors explored the effect of tumor length and number of positive lymph nodes on survival in patients with esophageal carcinoma.METHODS. Patients with esophageal adenocarcinoma or squamous cell carcinoma were subgrouped according to historic stage with localized, regional, or distant disease. Demographic factors (age at diagnosis, race, and gender) and tumor characteristics (morphology, histologic grade, tumor length, primary site, depth of invasion, number of positive lymph nodes, proportion of positive lymph nodes dissected, and distant metastatic sites) were examined.RESULTS. Overall factors that were associated with an increased mortality risk included increasing age at diagnosis, black race versus white race, histologic grade, primary tumor site in the lower esophagus and abdomen versus upper regions, and increasing depth of invasion. Among patients with regional disease, the number of positive lymph nodes (greater than or equal to 5 vs. < 5) was related to an increasing risk (hazard ratio [HR], 1.29; 95% confidence interval [95%CI], 1.06-1.56). The proportion of positive lymph nodes compared with the number of lymph nodes dissected conferred an increased risk (HR, 1.63; 95%.CI, 1.26-2.11). Among patients with distant disease, sites other than distant lymph nodes implied an increased mortality risk (HR, 1.37; 95%CI, 1.37-1.65). Tumor length was an independent predictor of mortality when controlling for depth of invasion in patients with localized disease (HR, 1.15; 95%CI, 1.08-1.21).CONCLUSIONS. Tumor length, the number of involved lymph nodes, and the ratio of positive lymph nodes are important prognostic factors for survival in patients with esophageal carcinoma. A revised TNM classification system for patients with esophageal carcinoma might consider adding tumor length and number of positive lymph nodes as two important prognostic factors.