食管癌淋巴结转移数量与生存率的相关性

Correlation between the number of metastatic lymph nodes and survival rate of esophageal cancer

目的探讨食管癌淋巴结转移数量与生存率的相关性及影响预后的危险因素。方法回顾性分析14132例食管癌患者临床资料，有淋巴结转移5930例为阳性组，无淋巴结转移8202例为阴性组；阳性组依据淋巴结转移数量分为N1（1～2个区域淋巴结转移）3210例、N2（3～6个区域淋巴结转移）1654例、N3（≥7个区域淋巴结转移）1066例；记录患者生存状况，分析年龄、性别、浸润深度、病理类型等与生存结局的关系，评价预后影响因素。结果阳性组1a生存率（43．66％）高于阴性组（14．12％），3、5a生存率（37．15％，19．19％）低于阴性组（45．39％、40．49％），差异均有统计学意义（P〈0．01）；阳性组N3患者1a生存率（82．46％）高于N2患者（59．79％）和N1患者（22．46％），差异均有统计学意义（P〈0．05）；单因素分析显示，年龄、浸润程度、分化程度、肿瘤部位、肿瘤直径与食管癌淋巴结转移有关，性别与淋巴结转移无关（P〉0．05）；多因素logistic回归分析显示，年龄〉50岁（HR=2．850，P=0．004）、低分化程度（HR=2．160，P=0．001）、食管下段肿瘤（HR=2．040，P=0．000）、肿瘤直径〉3cm（FIR=1．620，P=0．000）是食管癌淋巴结转移的高危因素。结论食管癌淋巴结转移数量与患者生存状态有关；年龄〉50岁、低分化程度、食管下段肿瘤、肿瘤直径〉3cm是食管癌淋巴结转移的主要影响因素。

Objective To investigate the correlation of the number of metastatic lymph nodes with the survival rate of esophageal cancer and the influencing factors for prognosis. Methods The clinical data of 14 132 patients with esophageal cancer were retrospectively analyzed, in which the patients with lymph node metastasis were as positive group （n= 5 930） and those without metastasis were as negative group （n= 8 202）. The positive group was divided into N1 （n= 3 210, 1 to 2 regions of lymph node metastasis）, N2 （n=1654, 3 to 6 regions of lymph node metastasis） and N3 （n=1066, ≥7 regions of lymph node metastasis） according to the number of metastatic lymph nodes. The survival status of patients was recorded, and the correlations of the survival results with the age, gender, depth of invasion and pathological type were analyzed to evaluate the influencing factors for the prognosis. Results The 1-year survival rate was significantly higher, and the 3- and 5-year survival rates were significantly lower in positive group （43.66%, 37.15%, 19.19%） than those in negative group （14. 12%, 45.39%, 40.49%） （P〈0.01）, and the 1-year survival rate was significantly higher in N3 patients （82.46%） than that in N2 patients （59.79%） and N1 patients （22. 46%） in positive group （P〈0.05）. The univariate analysis showed that age, infiltration degree, differentiation degree, tumor location and tumor size were correlated with lymph node metastasis, and the gender was not correlated with lymph node metastasis （P〉0.05）. The multivariate logistic regression analysis showed that age 〉 50 years （HR = 2. 850, P = 0. 004）, poorly differentiated degree （HR=2. 160, P=0. 001）, lower esophageal tumors （HR=2. 040, P=0. 000） and tumor diameter 〉3 cm （HR=1. 620, P=0. 000） were the high risk factors for lymph node metastasis in patients with esophageal cancer. Conclusion The number of metastatic lymph nodes is correlated with the survival status of the patients with esophageal cancer. The age 〉50 years, poorly differentiation, lower esophageal cancer and tumor diameter〉 3 cm are the main influencing factors for lymph node metastasis of esophageal cancer.