表浅型食管癌淋巴结转移相关危险因素分析和临床运用评估

Analysis of risk factors of lymph node metastasis of superficial esophageal cancer and its clinical application

目的探讨表浅型食管癌（SEC）患者淋巴结转移的危险因素及其临床运用评估情况。方法纳入2010年1月至2016年12月于南京医科大学第一附属医院行外科手术治疗的769例SEC患者，回顾性分析其病历资料。统计学方法采用卡方检验、logistic回归分析。评估术前诊断淋巴结转移的灵敏度和特异度，以及术前诊断病理类型、浸润深度的整体阳性准确率。结果SEC患者的淋巴结转移率为15.34%（118/769）。淋巴结转移组（118例）和无淋巴结转移组（651例）患者的饮酒情况、肿瘤最大径、组织病理类型、组织分化程度、浸润深度、脉管浸润差异均有统计学意义（χ^2＝5.66、13.71、40.65、20.04、36.70、61.51，P均〈0.05）。多因素分析显示，肿瘤最大径〉2 cm（OR＝1.76，95%CI 1.12～2.77）、组织分化程度为低分化（OR＝1.92，95%CI 1.23～3.01）、浸润至黏膜下层（OR＝2.67，95%CI 1.28～5.56）和有脉管浸润（OR＝5.28，95%CI 2.75～10.13）是SEC患者淋巴结转移的独立危险因素（P均〈0.05）。肿瘤部位与淋巴结转移部位相关（χ^2＝107.05，P〈0.01）。术前辅助检查诊断淋巴结转移的灵敏度为58%，特异度为59%。术前病理评估病变类型的整体阳性准确率为66.7%（440/660）。术前超声胃镜检查评估浸润深度的整体阳性准确率为27.9%（19/68）。结论对于肿瘤最大径≤2 cm、组织分化程度为高分化或中分化、肿瘤位于黏膜层、无脉管浸润的SEC患者，其淋巴结转移风险相对较小，内镜下治疗可行。

ObjectiveTo investigate the risk factors of lymph node metastasis （LNM） in patients with superficial esophageal cancer （SEC） and to evaluate its clinical application.MethodsFrom January 2010 to December 2016, 769 SEC patients, who received surgery in the First Affiliated Hospital of Nanjing Medical University, were enrolled, and their clinical data were retrospectively analyzed. Chi-square test and logistic regression analysis were performed for statistical analysis. The sensitivity, specificity, and overall positive accuracy of pathological type and depth of invasion before operation were evaluated.ResultsThe rate of LNM in patients with SEC was 15.34% （118/769）. There were significant differences in alcohol consumption, maximum tumor diameter, histological type, differentiation degree, depth of invasion and vascular invasion between patients with LNM （118 cases） and patients without LNM （651 cases） （χ^2=5.66, 13.71, 40.65, 20.04, 36.70 and 61.51; all P〈0.05）. The results of multivariate analysis showed that maximum tumor diameter〉2 cm（odd ratio （OR） 1.76, 95% confidence interval （CI） 1.12 to 2.77）, poor differentiation（OR 1.92, 95%CI1.23 to 3.01）, submucosal invasion（OR 2.67, 95%CI 1.28 to 5.56） and vascular invasion （OR 5.28, 95%CI2.75 to 10.13） were independent risk factors of LNM in patients with SEC. The tumor location was significantly correlated with the site of LNM （χ^2=107.05, P〈0.01）. The sensitivity and specificity of preoperative assessment of LNM were 58%（51/88） and 59%（301/510）, respectively. The overall positive accuracy of histological type before operation was 66.7%（440/660）. The overall positive accuracy of depth of invasion evaluated by endoscopic ultrasound before operation was 27.9%（19/68）.ConclusionEndoscopic treatment is recommended for SEC patients with maximum tumor diameter ≤2 cm, high ormoderate degree of differentiation, tumor confined to the mucosal layer and without vascular metastasis for the relatively low risk of LNM.