Comparison Of Postoperative Survival Distribution,prognostic Factors In 217 Patients With Esophagogastric Junction Cancer

Objective: Esophagogastric junction cancer(EGC)is one of the most common digestive tract malignant tumors.China is one of the high incidence areas of EGC in the world.The diagnosis and treatment of EGC has always been the focus of medical research in China.Nowadays,the main treatment of EGC is surgical resection.In view of this,our study focused on 217 patients with EGC underwent radical resection from January 2010 to January 2014 in department of thoracic surgery,Eastern Hospital of the fourth hospital of Hebei Medical University,then,we drew survival curve and analyzed the factors influencing the survival time of patients after operation,afterward,to provide a reference for the development of more accurate surgical treatment strategies.Methods:We selected 273 patients with EGC in our department and carride out the investigation and follow-up.Then we used the life table method to analyze the survival data of 217 patients who met the criteria,and plotted the survival curve.At the same time,cox proportional hazards model was performed to carry out multivariate analysis.Taken the age,sex,operation mode,histological type,degree of G,depth of T,number of lymph node dissection and positive number,as covariates.At last,the optimal surgical approach for EGC was summarized.Resoults:1 The 3-year and 5-year survival rates of patients with EGC were about62% and 50%,respectively,the median survival time was 60 months(Fig.1).2 Log-rank single factor analysis showed that different surgical approaches,degree of G,depth of T,abdominal lymph node metastasis,especially left gastric lymph nodes and cardiac lymph nodes,gastric lymph nodes,stump positivity,the presence of postoperative recurrence or metastasis,preoperative gastroscopy to determine tumor invasion and the tooth line distance are the prognostic factors of EGC.But the age,cardiovascular disease and diabetes,histopathological type,blood vessel,mediastinal lymph node metastasis(especially low of esophageal lymph node metastasis),preoperative endoscopic invasion of the stomach were not prognostic factors of EGC(Table 1).3 Multivariate analysis of Cox proportional hazards model demonstrated that adjusted for confounding effects of other factors in the group,age,lymph node metastasis,positive stump,invasion length of esophagus and operation approaches were prognostic factors of EGC.Moreover,the risk of death in patients with EGC was increased by 7%,with age increasing by 1 year.The metastasis of abdominal lymph node and positive stump were the risk factors.The risk of postoperative death was increased by 9%,with invasion length of esophagus increased by 1cm.Different levels in different surgical approaches showed that the mortality rate was higher in abdomen than thoracic(Table 2).Conclusions:1 After operation,the survival rate of patients with EGC was been improved,especially in the thoracic surgery path,which is higher than abdominal.2 The prognosis of the patients with older age,lymph node metastasis,and the greater invasion length of esophagus in the EGC was poor.