胸段食管癌微创根治术后胃左动脉旁淋巴结转移危险因素分析

Logistic regression analysis of risk factors for lymph node metastasis along left gastric artery after minimally invasive radical resection of thoracic esophageal carcinoma

目的:分析胸段食管癌患者实施微创根治术后发生胃左动脉旁淋巴结转移情况及其危险因素。方法:回顾2014年1月至2019年3月收治的212例胸段食管癌微创根治术患者的资料,统计术后胃左动脉旁淋巴结转移的发生情况,并据此分为发生组和未发生组,进行危险因素分析。结果:有48例发生胃左动脉旁淋巴结转移,发生率为22.64%;发生组低分化、T_(3)分期、肿瘤直径>5 cm、脉管癌栓、内切缘阳性构成比高于未发生组(P<0.05),放疗、化疗构成比低于未发生组(P<0.05);经Logistic回归分析,低分化、T_(3)分期、肿瘤直径>5 cm、脉管癌栓、内切缘阳性均是胸段食管癌微创根治术后胃左动脉旁淋巴结转移的独立危险因素(OR=2.883、2.227、5.369、7.643、4.904,P<0.05),放疗、化疗是其保护因素(OR=0.755、0.917,P<0.05)。结论:低分化、T_(3)分期、肿瘤直径>5 cm、脉管癌栓、内切缘阳性均可增加胸段食管癌微创根治术后胃左动脉旁淋巴结转移的风险,应对存在上述危险因素者加强防控;放疗和化疗则可降低其风险,有放化疗指征者应及早实施放化疗。

Objective:To analyze of gastric left paracentral lymph node metastasis and its risk factors after minimally invasive radical surgery in patients with thoracic esophageal cancer.Methods:The data of 212 patients undergoing minimally invasive radical surgery for thoracic esophageal cancer from January 2014 to March 2019 were reviewed and analyzed.The incidence of lymph node metastasis along the left gastric artery after operation was statistically analyzed,and the patients were divided into occurrence group and non occurrence group by this.Then the risk factors were analyzed.Results:48 cases had lymph node metastasis along the left gastric artery,and the incidence was 22.64%.The proportions of low differentiation,T3 stage,tumor>5 cm,vascular cancer thrombus and positive internal margin in the occurrence group were higher(P<0.05),while radiotherapy and chemotherapy were lower than those in the non occurrence group(P<0.05).Logistic regression analysis showed that low differentiation,T3 stage,tumor>5 cm,vascular tumor thrombus and positive internal margin were independent risk factors for lymph node metastasis along the left gastric artery after minimally invasive radical resection of thoracic esophageal carcinoma(OR=2.883,2.227,5.369,7.643,4.904,P<0.05).Radiotherapy and chemotherapy were the protective factors(OR=0.755,0.917,P<0.05).Conclusion:Low differentiation,T3 stage,tumor>5 cm,vascular tumor thrombus and positive internal margin can increase the risk of lymph node metastasis along the left gastric artery after minimally invasive radical resection of thoracic esophageal carcinoma,and prevention and control should be strengthened for those with the above risk factors,while radiotherapy and chemotherapy can decrease the risk,and patients with indications of radiotherapy and chemotherapy should be given radiotherapy and chemotherapy as soon as possible.