Multivariate Analysis Of Prognostic Factors Of Esophageal Cancer And Gastric Cardia Carcinoma After Radical Surgery By Cox Proportional Hazard Model

Objective: It is well known, the most effective treatment for the patients with esophageal cancer and gastric cardia adenocarcinoma was radical surgery. But a lot of factors affect the prognosis, including clinical, pathological and many other aspects. In order to thoroughly understand the prognosis of esophageal and gastric cardia adenocarcinoma. This study summarizes our hospital clinical material based on reviewing the literature of domestic and foreign, for the purpose of discussing the prognosis factors of Esophageal cancer and gastric cardia adenocarcinoma.Method: According to the selection criteria, the data of 6241 hospitalized patients with the esophageal cancer and gastric cardia adenocarcinoma in the Fourth Hospital of Hebei Medical University from January 1996 to December 2004 were reviewed. The questionnaires were input to ACESS database after it was encoded. We used random sampling method and selected 1040 cases to do this study. A follow-up study was carried out on the sample, and follow-up was made by post letter, phone-call in those patients. For the follow-up, the operation time was looked as the starting point and the end point was missing or lately time of follow-up. In the study, dead from cancer was the termination.Reference to some other studies, we collected twelve possible factors influencing survival of these patients. All analyses were performed by using SPSS13.0 software package. Chi-square test was used for the enumeration data to comparison, and the univariate and multivariate analysis of these individual variables were performed by Cox proportional hazard model. All tests were performed at the 0.05 level of significances.Result: We randomly selected 1040 cases to be follow-up. 906 cases were visited and the lost rate was 12.89%.The results of this study were as follows:1 According to age on operation, the patients'age ranged from 24 to 80 years, the average age was 57.82±8.6 years, meso age was 58 years. We analyzed 3 groups (age on operation was≤50, 50-60, >60 respectively)and confirmed the frequency distribution among different years existed obvious variance. By Tendency Analysis, it was proved that as times went on, the constituent radio of elder patients who accepted operation had been increasing.2 We analyzed symptoms on admission and found that patients'chief complaints were different for their different diseased regions. Overall, the main symptom was swallowing difficulty, moreover, pain with swallowing was a frequent simultaneous phenomenon in esophageal disease, middle and inferior esophageal disease was always accompanied with singultus, however, in cardiac part disease, patients often felt abdominal pain, distention or singultus.3 Twelve possible factors influencing survival of these patients were encoded. We analyzed the prognostic factors of esophageal cancer and gastric cardia carcinoma after radical surgery by Cox proportional hazard model.On univariate analysis: sex, tumour location, operative incision type, the specimen's stump and vas tumor embolus had no significantly(P>0.05);but age, tumor diameter, pathological type, nearby organs involved and the clinical stage influenced the prognosis significantly(P<0.01).On multiplicity analysis: pathology type, number of lymphaden metastasis, nearby organs involved and clinical stage were independent prognostic factors.Survival of the radical resection group were 0.898±0.010,0.754±0.016 at 1,3years and 0.717±0.018 at 5 years, Which Were higher than those of operation cases from 1984 to 1989 in the Fourth Hospital of Hebei Medical University.Conclusion:1 By analyzing esophageal cancer and gastric cardia carcinoma after radical surgery in the recent decade in the Fourth Hospital of Hebei Medical University, it's proved that the independence factors which can influence prognosis are: pathology type, clinical stage, number of metastatic lymphaden, nearby organs involved; other main factors related with prognosis contains: age, length of tumor and depth of invasion.2 Small cell anaplastic carcinoma suggests worse prognosis than any other pathology type.3 Lymphaden positive suggests worse prognosis than lymphaden negative, especially the number of metastatic lymphaden exceeds 3.4 Nearby organs involved suggests worse prognosis, and should take close follow-up.5 The 1 year, 3 years, 5 years survival rate of the recent decade are higher than those of 1980s in Chest Surgery of the Fourth Hospital of Hebei Medical University.