食管癌患者术后病灶转移流行病学调查及相关危险因素分析

Epidemiological studies investigating risk factors for postoperative metastasis of esophageal cancer

目的调查食管癌术后患者发生病灶转移的流行病并分析其相关危险因素。方法回顾性分析2018年8月至2019年7月确诊并行食管癌手术患者153例,按照其术后有无发生病灶转移分为转移组与未转移组,其中转移组患者有75例,未转移组患者78例。采用本院自拟的调查问卷对术后患者进行流行病学调查;结合术前食管癌诊断结果单因素分析影响食管癌患者术后病灶转移的相关因素,采用二元Logistic回归模型分析影响食管癌术后患者病灶转移的危险因素;对术后患者进行跟踪随访2年,观察病灶不同转移位置对存活率的影响。结果在153例食管癌术后患者中,发生病灶转移75例(49.02);在5例病灶转移的患者中区域性转移46例(61.33),远处病灶转移29例(38.67);单因素分析表明分化程度、病灶转移到淋巴结情况、患者血清中血管内皮生长因子-C(VEGF-C)、组织多肽特异抗原(TPS)水平是影响食管癌术后患者病灶转移的相关因素(P<0.05);Logistic回归多因素表明分化程度中等以下、区域淋巴结有2枚以上癌转移、VEGF-C水平>8.52μg/L、TPS水平>259.64 U/L是食管癌术后患者发生病灶转移的危险因素(P<0.05);随访2年显示病灶发生区域转移的死亡率略高于远处病灶转移。结论影响食管癌术后患者病灶发生转移的主要危险因素为分化程度、病灶转移到淋巴结数量及患者血清中TPS及VEGF-C水平升高,且病灶远处转移的死亡率低于区域性病灶转移。

Objective To investigate the epidemiology of postoperative metastasis of esophageal cancer(EC)and analyze the related factors.Methods In this retrospective study,patients(n=153)underwent EC surgery in our hospital from August 2018 to July 2019 were as subjects,grouping into metastatic group(n=75)and non-metastatic group(n=78)according to presence/absence of metastasis.A self-made questionnaire was perpormed for epidemiology of postoperative metastasis.Univariate analysis was conducted for postoperative metastasis related factors based on preoperative diagnosis results.Binary Logistic regression model was conducted to assess the risk factors.A 2-year Follow-up was carried out to observe the effect of different locations on survival rate.Results Totally 75(49.02%)had metastasis including 46(61.33%)of regional metastasis and 29(38.67%)of distant metastasis.Univariate analysis showed that the degree of differentiation,depth of invasion,Vascular endothelial growth factor-C(VEGF-C)and tissue polypeptide specific antigen(TPS)levels were related factors for EC postoperative metastasis(all P<0.05).Logistic regression showed that the risk factors for EC postoperative metastasis were moderate differentiation,more than 2 metastases in regional draining lymph nodes(RDLs),VEGF-C level>8.52μg/L and TPS level>259.64U/L.The 2-year follow-up showed that the mortality rate of regional metastasis was slightly higher than that of distant metastasis.Conclusion The main risk factors for EC postoperative metastasis are the degree of differentiation,the number of metastasis to lymph nodes,and the serum levels of TPS and VEGF-C,and the mortality rate of distant metastasis is superior to that of regional metastasis.