建立评分系统预测胸中下段食管鳞癌颈部淋巴结转移风险

Establishing a Scoring System to Predict the Risk of Cervical Lymph Node Metastasis in Thoracic Middle-lower Segment Esophageal Squamous Carcinoma

目的建立评分系统精确预测胸中下段食管鳞癌颈部淋巴结转移的风险,探讨其颈部淋巴结的治疗策略。方法回顾性分析219例食管鳞癌切除术患者的临床及病理资料,通过单因素和多因素分析胸中下段食管鳞癌颈部淋巴结转移的独立危险因素,综合独立危险因素,建立临床模型,权衡临床模型的贝塔系数,建立评分系统。应用评分系统对219例患者进行评分,并分为低、中、高3个危险组,探讨颈部淋巴结转移合适的治疗策略。结果颈部淋巴结转移发生率为30.59%(67/219)。单因素及多因素分析结果显示,胸中下段食管鳞癌颈部淋巴结转移的独立危险因素为肿瘤位置、肿瘤长度(>5.25cm)、肿瘤分化。建立临床模型,权衡临床模型贝塔系数建立评分系统:胸中段3分(2.66),肿瘤长度>5.25cm(1.20)和肿瘤低分化2分(1.55),肿瘤中分化1分(0.35)。依患者的得分情况分为3组:低危组(0~2)、中危组(3~4)及高危组(>4),3组颈部淋巴结转移发生率分别为3.03%,26.19%和55.00%(P<0.05)。结论建立的评分系统可以在术前精确预测胸中下段食管鳞癌颈部淋巴结转移的风险,为术中淋巴结清扫临床决策提供参考,低危组推荐不行颈部淋巴结清扫,高危组推荐行颈部淋巴清扫或术后放疗。

Objective To establish a scoring system to accurately predict the risk of cervical lymph node metastasis in thoracic middle-lower segment esophageal squamous cell carcinoma,and to explore reasonable treatment strategies for the cervical lymph nodes by analyzing the associated risk factors of cervical lymph node metastasis in thoracic middle-lower segment esophageal squamous cell carcinoma.Methods Retrospective we analyzed 219 cases of esophageal squamous carcinoma patients who underwent esophagectomy,through single factor and multiple factors analysis of independent risk factors of cervical lymph node metastasis in thoracic middle-lower segment esophageal squamous cell carcinoma. We then established a clinical model to take into account the independent risk factors,and built the scoring system by usingβcoefficient to weigh the clinical model. The scoring system was employed to divide the 219 patients into high-risk,medium-risk,and low-risk groups;we then explore reasonable treatment strategies for the cervical lymph nodes. Results The incidence of cervical lymph node metastases was 30.59%（67/219）. The single factor and multiple factor analyses showed the independent risk factors for esophageal squamous carcinoma of cervical lymph node metastasis were：tumor location,tumor length（〉5.25 cm）,and tumor differentiation degree. Clinical model was set up and the scoring system was built with the use ofβcoefficient that weighed the clinical model：3 points for thoracic middle segment（2.66）,1 point for tumor length〉5.25 cm（1.20）,2 points for poorly differentiated tumor（1.55）,and1 point for moderately differentiated tumor（0.35）. Patients were divided into three groups according to their scores：low-risk group（0-2）,moderate risk group（3-4）,and high-risk group（〉4）. Cervical metastasis rates for the three groups were 3.03%,26.19%,and 55.00% respectively（P〈0.05）.Conclusion Establishing a novel and practical scoring system can accurately predict preoperatively the risk of cervical lymph node metastasis in thoracic middle-lower segment esophageal squamous carcinoma,and provide clinical reference for the lymph node decision intraoperatively. For low-risk groups no neck lymph node cleaning is recommended,for high-risk groups neck lymph node cleaning or postoperative radiotherapy is recommended.