局限于黏膜下层食管癌淋巴结转移风险的相关因素分析

Risk factor analysis of lymph node metastasis of submucosal esophageal carcinoma

目的本研究旨在分析局限于黏膜下层肿瘤(T1b)食管鳞癌的淋巴结转移危险因素及评估其风险。方法回顾性分析112例T1b食管鳞癌患者的病例资料及病理检查报告,其中80例无淋巴结转移的病例作为对照组(N0组),32例有淋巴结转移的作为实验组(N1组)。重新进行肿瘤标本的镜下检查,包括肿瘤的长度、浸润深度及淋巴管和血管的浸润,将T1b浸润深度分为上1/3、中1/3、下1/3(submucosal 1、submucosal 2、submucosal 3,SM1、SM2、SM3)并对淋巴结转移因素进行分析。结果单因素logistics回归分析显,示肿瘤浸润深度、长度和分化程度是影响淋巴结转移的危险因素,多因素logistics回归分析显示,肿瘤分化程度是影响淋巴结转移的独立危险因素(P<0.001),去除肿瘤分化程度的多因素logistics回归分析显示,肿瘤浸润深度是淋巴结转移的第二独立影响因素(P=0.023)。结论 T1b食管鳞癌患者的淋巴结转移风险较高,影响因素较多,对于易发生淋巴结转移的患者,外科手术应继续作为标准治疗方法。

Objective To investigate the risk factors of lymph node metastasis in Tlb esophageal squamous carcinoma and evaluate its risk. Methods The clinical data and pathological reports of 112 patients with Tlb esophageal squamous carcinoma were retrospectively analyzed. Among them, 80 patients without lymph node metastasis were served as control group（group NO）, and the other 32 patients with lymph node metastasis were classified into experiment group （group N l ）. Tumor specimens were reevaluated for tumor length, depth of tumor infiltration as well as lymphatic and vascular infiltration. The depth of submucosal tumor infiltration was divided as upper third, middle third and lower third （submucosal 1, SM1; submucosal 2, SM2; and submucosal 3, SM3） , and factors influencing lymph node metastasis were assessed. Results Univariate logistic regression analysis showed that depth of tumor infiltration, tumor length and tumor differentiation were risk factors of lymph node metastasis. Multivariate logistic regression analysis indicated that tumor differentiation was independent risk factor of lymph node metastasis （P〈0.001）. In the absence of tumor differentiation, multivariate logistic regression analysis revealed that the second independent risk factor of lymph node metastasis was depth of tumor infiltration （P=0.023）. Conclusion The risk of lymph node metastasis of Tlb esophageal squamous carcinoma is high, with many influencing factors, and esophagectomy should sequentially be the standard treatment for those prone to lymph node metastasis.