中文摘要：

目的探讨影响食管癌根治性切除术后患者预后的相关因素，为术后综合治疗方案的选择提供参考依据。方法回顾性分析2002年5月至2006年6月，行食管癌根治性切除术的患者618例，既往无恶性肿瘤病史，术前未行放疗或化疗，卡氏评分均i〉70分，术后临床病理资料完整。选择对预后生存可能有影响的临床病理资料和术后放疗情况进行单因素和多因素分析。结果618例患者1、3、5年总生存率分别为83．32％、53．33％和36．02％，中位生存期为38．33个月。无淋巴结转移者，单纯手术组和术后放疗组的术后生存时间差异无统计学意义；有淋巴结转移者，术后放疗组1、3、5年生存率分别为94．34％、51．55％和34．41％，高于单纯手术组（分别为63．08％、23．30％和4．36％，P〈0．01）。单因素生存分析结果显示，术前饮食情况、手术切除方式、术中显示肿瘤长度、术中显示肿瘤外侵情况、与周围组织粘连程度、T分期、N分期、TNM分期、淋巴结清扫数目、淋巴结转移度、淋巴结转移数、淋巴结转移区域数、肿瘤病理类型、细胞分化程度和脉管瘤栓情况与食管癌患者预后有关（均P〈0．05）；术后化疗能够改善食管癌患者的生存时间（P〈0．001）；按照有无淋巴结转移分层进一步分析，在有淋巴结转移的情况下，术后预防照射有助于改善患者的预后（P〈0．001）。Cox回归分析结果显示，手术切除方式、术中肿瘤外侵程度、病理T分期、淋巴结转移数和淋巴结转移区数是影响患者术后预后的独立危险因素。结论手术切除方式、术中肿瘤外侵程度、病理T分期、淋巴结转移数和淋巴结转移区数是食管癌根治术后患者预后的独立影响因素，食管癌根治术后预防性照射对有淋巴结转移的患者有益。

英文摘要：

Objective To explore factors affecting the survival in patients after radical resection of esophageal carcinoma, and to provide a valuable reference for selecting treatment protocol after surgery. Methods Clinicopathological data of 618 esophageal cancer patients who underwent radical resection at the Fourth Hospital of Hebei Medical University from May 2002 to June 2006 were collected and reviewed in this study. All patients had no cancer history, did not receive preoperative radiotherapy or chemotherapy, and had Karnofsky performance scores t〉 70. Univariate analysis was performed by using log-rank test to determine predictors of survival, and multivariable analysis was performed by a Cox regression model. Results The overall 1-, 3-, 5-year survival rates were 83.32% , 53.33% , 36.02% , respectively, and the median survival time was 38.33 months. The Cox regression analysis showed that operation mode, intraoperative findings of the extent of tumor invasion, pathological T stage, and the number of metastatic lymph nodes were significant predictors of survival. For patients with lymph node metastasis, the overall 1-, 3-, and 5-year survival rates did not significantly differ between the operation alone group and the postoperative prophylactic radiotherapy group. For patients without lymph node metastasis, the 1-, 3-, and 5-year survival rates were 94.3%, 51.55%, and 34.41%, respectively, in the postoperative radiotherapy group, significantly higher than those in the operation alone group （63.08%, 23.30% and 4.36% ; X2 = 15.99, P 〈0.01 ）. Conclusions The independent prognostic factors of esophageal cancer patients afterradical resection include the operation mode, intra-operative findings of the extent of tumor invasion, pathological T stage, the number of lymph node metastasis and the number of regions of lymph node metastasis. Postoperative prophylactic radiotherapy is beneficial for esophageal cancer patients with lymph node metastasis.