| 张 鹏,单国平,封 巍.食管癌脑转移123例患者的临床特征和预后分析[J].肿瘤学杂志,2023,29(12):1040-1048. |
| 食管癌脑转移123例患者的临床特征和预后分析 |
| Influencing Factors of Prognosis in Patients with Esophageal Carcinoma Brain Metastasis |
| 投稿时间：2023-09-27 |
| DOI：10.11735/j.issn.1671-170X.2023.12.B009 |
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| 中文关键词: 食管肿瘤 脑转移 预后 临床特征 |
| 英文关键词:esophageal neoplasms brain metastasis prognosis clinical characteristics |
| 基金项目:浙江省卫生医药科技项目（新技术产品研发）（2022PY006） |
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| 中文摘要: |
| 摘 要：［目的］ 分析食管癌脑转移患者的临床特征和预后影响因素。［方法］ 回顾性分析1993年1月1日至2022年12月31日浙江省肿瘤医院收治的123例食管癌脑转移患者的临床资料。采用Kaplan-Meier法分析患者的临床病理特征与生存的关系，并采用Cox回归法进行多因素预后分析。［结果］ 123例食管癌脑转移患者中，65例（52.8%）患者临床分期为Ⅳ期，N2、N3期患者15例，M1期60例。食管癌首诊时发现：侵及全层93例，隆突下淋巴结阳性30例，锁骨上淋巴结肿大48例，同时肝转移15例。脑转移单发灶（脑转移首诊时）68例，无颅外转移史42例。食管癌原发灶手术+化疗治疗患者5年生存率最高（33.3%），各种治疗方式间生存率比较差异有统计学意义（P＜0.001），原发灶靶向和免疫治疗对生存的影响无统计学意义（P>0.05）。随访123例患者中，共死亡113例。食管癌确诊后总中位生存时间1.87年，食管癌脑转移患者 1、3、5年生存率分别为69.7%、31.4%、11.8 %。食管癌临床分期、N分期、M分期、隆突下淋巴结阳性、锁骨上淋巴结阳性、食管癌首诊同时肝转移等临床特征组间生存率比较差异均有统计学意义（P＜0.05）。多因素分析结果显示，食管癌发病年龄、M分期、隆突下淋巴结、食管癌首诊同时肝转移是预后的独立影响因素（P均＜0.05）。［结论］ 发病年龄越小，低M分期，隆突下淋巴结阴性和食管癌首诊同时无肝转移的食管癌脑转移患者预后相对较好。 |
| 英文摘要: |
| Abstract： ［Objective］ To analyze the influencing factors of prognosis in patients with esophageal carcinoma brain metastases. ［Methods］ The clinical data of 123 patients with brain metastases from esophageal carcinoma admitted to the Zhejiang Cancer Hospital from January 1993 to December 2022 were retrospectively analyzed. The relationship between clinicopathological characteristics and survival of patients was analyzed by Kaplan-Meier， and the factors related to the prognosis of patients were analyzed by multivariate Cox regression. ［Results］ Among 123 patients with esophageal cancer brain metastasis there were 65 cases of stage Ⅳ， 15 cases of N2 or N3 stage， and 60 cases of M1 stage. When esophageal carcinoma was first diagnosed， 93 cases had full layer invasion， 30 had positive lymph nodes under the carina tracheae， 48 has supraclavicular lymph node enlargement， and 15 had simultaneous liver metastasis. Sixty eight patients had single lesion brain metastasis， and 42 patients had no history of extracranial metastasis. There were significant differences in survival times among patients receiving different treatment modalities (P<0.001)， and the 5-year survival of patients treated with a combination of surgery and chemotherapy was the highest (33.3%). There was no significant impact of primary tumor targeting and immunotherapy on the survival(P>0.05). A total of 113 died during the follow-up； the overall median survival time was 1.87 years， and the 1-year， 3-year and 5-year survival of patients were 69.7%， 31.4%， and 11.8%， respectively. The survival time was significantly associated with clinical stage， N stage， M stage， metastases of lymph nodes under the trachea carina and in the supraclavicular region， and simultaneous liver metastasis (P<0.05). Multivariate analysis showed that the onset age， M stage， positive lymph nodes under the trachea carina， and simultaneous liver metastasis were independent influencing factors on prognosis of patients (all P<0.05). ［Conclusion］ Patients with esophageal cancer brain metastasis who have a younger onset age， lower M stage， negative lymph nodes under the carina， and no liver metastasis at the first diagnosis have a relatively better prognosis. |
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