食管鳞癌大体类型与淋巴结转移的关系

The correlation between tumor gross types and lymph node metastasis in esophageal squamous cell carcinoma

目的：探讨食管鳞癌大体类型与淋巴结转移的关系。方法52470例食管鳞癌患者来自河南省食管癌重点开放实验室50万例食管及贲门癌生物样本资料库（1973-2015年），具有详细大体类型和淋巴结转移记录。采用χ2检验分析大体类型在各种临床特征间的分布差异；Spearman 秩相关和 Logistic 回归分析4种大体类型与淋巴结转移的关系。结果食管鳞癌4种大体类型中，溃疡型最常见（45.0%），其次为髓质型（40.9%）和蕈伞型（10.0%，），缩窄型最少见（4.1%）。缩窄型患者淋巴结转移阳性率最高（45.4%），其次为髓质型（42.6%）和溃疡型（40.9%），蕈伞型淋巴结转移阳性率最低（35.0%）（P ﹤0.05），Spearman 秩相关分析结果显示显著相关（P ﹤0.05）；校正混杂因素后 Logistic 回归显示，食管鳞癌4种大体类型是淋巴结转移的重要影响因素：溃疡型，髓质型，缩窄型相对于蕈伞型风险依次升高。结论食管鳞癌大体类型与淋巴结转移密切相关，可作为临床评判淋巴结转移风险的重要参考指标。

Objective To explore the correlation between tumor gross types and lymph node metastasis in esophageal squa-mous cell carcinoma. Methods A total of 52 470 patients with esophageal squamous cell carcinoma were derived from 500 000 cases of esophageal and gastric cardia carcinoma database（1973 - 2015）in Henan Key Laboratory for Esophageal Cancer Re-search in the First Affiliated Hospital of Zhengzhou University. The chi - square test was used to analyze the differences of gross tumor types and lymph node metastasis. Spearman rank correlation and Logistic regression analysis were applied to correlate the relationship between four kinds of tumor gross types and lymph node metastasis. Results In the four gross tumor types,the ulcer type was the most common（45. 0% ）,followed by medullary type（40. 9% ）and mushroom type（10. 0% ）. The narrow type was less common（4. 1% ）. The positive rate of lymph node metastasis was the highest in patients with narrow type（45. 4% ）, followed by medullary type（42. 6% ）and ulcer type（40. 9% ）,and the fungating type was the lowest（35. 0% ）（P ﹤ 0. 05）. Spearman rank correlation analysis showed a significant correlation（P ﹤ 0. 05）. Logistic regression showed that after adjustment for confounding factors,tumor gross type was one of the important factors to affect lymph node metastasis in esophageal squamous cell carcinoma with an increase in ulcer,medullary and narrow type. Conclusion The gross tumor types were closely associated with the risk of lymph node metastasis in esophageal squamous cell carcinoma and could be used as an important reference index to evaluate lymph node metastasis before surgery.