Ⅱ型贲门腺癌口侧切缘残留癌的多因素Logistics分析

Multivariate analysis of positive oral margin in type Ⅱ adenocarcinoma of esophagogastric junction

目的筛选和确定Ⅱ型贲门腺癌患者发生口侧切缘癌残留的危险因素,为临床上减少切缘癌残留、提高根治性切除率提供指导。方法回顾分析1998年1月至2007年1月行手术治疗的61例Ⅱ型贲门腺癌患者的临床资料,应用单因素和多因素分析方法对可能影响口侧切缘癌残留的因素进行筛选,分别应用卡方检验、秩和检验评估口侧切缘癌残留对吻合口瘘、术后早期并发症、术后住院时间的影响。结果口侧切缘癌残留发生率为8.2%,口侧切缘癌残留与吻合口瘘、术后早期并发症、术后住院时间的关系均无统计学意义。在单因素分析提示对口侧切缘癌残留有意义的影响因素包括口侧切除长度、肿瘤长径和腺癌分化程度。多因素分析中,只有口侧切除长度对口侧切缘癌残留的影响有统计学意义(P=0.0461)。结论口侧切缘癌残留对短期预后无影响,Ⅱ型贲门腺癌口侧切缘癌残留与口侧切除长度有关,要减少切缘癌残留的发生需保证最少6cm的口侧切除长度。

Objective To identify main risk factors influencing positive oral margin for type Ⅱ adenocarcinoma of esophagogastric junction.Methods Retrospective analyzing the data of 61 patients with type Ⅱ adenocarcinoma of esophagogastric junction who received operation between January 1998 and December 2006.A Logistic regression model was built to identify by multivariate analysis the variables independently associated with positive oral margin.Results Rate of positive oral margin was 8.2%.By univariate analysis,factors predictive of positive oral margin were length of oral margin,maximum diameter of tumor and differentiation degree of tumor.By multivariate analysis,significant factors predictive of positive oral margin was only length of oral margin（P=0.0461）.The relationship between positive oral margin and anastomotic leak,Postoperative morbidity,postoperative hospital stay were all insignificant.Conclusions Positive oral margin did not influent short-term outcome.Rate of positive oral margin was influented by length of oral margin.Oral margin length of at least 6 cm in situ was required to achieve a microscopically negative proximal margin.