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目的：应用 Cox模型和 Kaplan- Meier生存分析方法，对可能影响食管鳞癌术后生存时间的临床和病理因素的相关性进行了分析。方法：我科 1991年 8月～ 1996年 3月行胸段食管癌切除术并经病理证实为原发性食管鳞癌的患者共 136例，排除手术死亡 4例，有完整随访资料的 115例。结合临床和病理情况及预后相关资料，选择性别、年龄、肿瘤部位等 14个有关食管鳞癌术后生存的非重复特征性因素进行分层，应用 STATA 5.0计算机统计软件行单因素和多因素分析。结果： 115例胸段食管鳞癌的术后中位生存期为 37个月， 1， 3， 5年术后生存率分别为 92.1％， 51.5％， 30.2％。单因素分析结果表明：食管鳞癌病变长度≥ 5 cm的患者比<3 的预后差，术后病检残端癌阳性的比阴性的预后差，有淋巴结转移的患者比无淋巴结转移的预后差，且转移淋巴结数量越多，预后越差，肿瘤浸润食管壁越深， ＴＮＭ 分期越晚，预后越差。进一步Ｃox 多因素分析表明只有肿瘤浸润深度和转移淋巴结数量是胸段食管鳞癌的独立预后因素。结论：目前食管癌 ＴＮＭ分期标准没有考虑到转移淋巴结的数量在食管癌预后中的rrrrrrrrrn重要意义，导致不能很准确的判断预后，因而需改进和修正。对中晚期食管鳞癌，尤其是位于胸中上段食管鳞癌可以考虑术前术后辅?
OBJECTIVE: To analyze the correlation between clinical and pathological factors that may affect the survival time of esophageal squamous cell carcinoma by using Cox model and Kaplan-Meier survival analysis method. METHODS: A total of 136 patients with primary esophageal squamous cell carcinoma who underwent thoracic esophageal cancer resection and were pathologically diagnosed from August 1991 to March 1996 were included in this study. Four patients were excluded from the operation and 115 patients had complete follow-up data. . Combined with clinical and pathological conditions and prognosis related data, 14 non-repeating characteristics related to postoperative survival of esophageal squamous cell carcinoma including sex, age, and tumor site were selected and stratified. Single factor and multivariate analysis were performed using STATA 5.0 computer statistical software. . RESULTS: The median postoperative survival of 115 patients with thoracic esophageal squamous cell carcinoma was 37 months. The postoperative survival rates at 1, 3, and 5 years were 92.1%, 51.5%, and 30.2%, respectively. The univariate analysis showed that the prognosis of patients with esophageal squamous cell carcinoma lesions ≥ 5 cm was worse than that of <3, and the prognosis of postoperative squamous cell carcinoma was more negative than that of negative ones. Patients with lymph node metastasis had worse prognosis than those without lymph node metastasis. The greater the number of metastatic lymph nodes, the worse the prognosis. The deeper the tumor infiltrating the esophagus, the later the TNM stage and the worse the prognosis. Further Cox multivariate analysis showed that only the depth of tumor invasion and the number of metastatic lymph nodes were independent prognostic factors of thoracic esophageal squamous cell carcinoma. Conclusion: The current TNM staging criteria for esophageal cancer do not take into account the significance of the number of metastatic lymph nodes in the prognosis of esophageal cancer, leading to inaccurate judgments. The prognosis, and therefore need to be improved and corrected. For advanced esophageal squamous cell carcinoma, especially in the upper and middle thoracic esophageal squamous cell carcinoma, preoperative and postoperative adjuvant can be considered.