胸段食管鳞状细胞癌淋巴结转移的危险因素分析

Risk factors of lymph node metastasis in ⅠA-ⅣA stage esophageal squamons cell carcinoma

目的探讨胸段食管鳞状细胞癌淋巴结转移的危险因素,并建立预测模型。方法回顾性分析郑州大学第一附属医院胸外科2013-01—2016-12间实施的628例食管癌切除术且病理处于ⅠA～ⅣA期患者的临床病理资料。年龄28～82岁;男394例,女234例。经右胸开放手术165例,胸腔镜手术463例。所有手术均采用UICC指南行系统性淋巴结清扫。应用χ~2检验和t检验对淋巴结转移与危险因素的相关性进行单因素分析,以Logistic回归行多因素分析,并建立预测模型。结果单因素分析结果显示,胸段食管癌淋巴结转移与性别(χ~2=11. 135,P=0. 001)、吸烟(χ~2=10. 325,P=0. 008)、饮酒(χ~2=7. 137,P=0. 001)、p T分期(χ~2=75. 733,P=0. 001)、G分期(χ~2=60. 261,P=0. 001)和脉管浸润(χ~2=35. 092,P=0. 001)有关。多因素分析结果显示,男性、病理肿瘤T分期增加、肿瘤分化程度和脉管浸润是胸段食管癌淋巴结转移的独立危险因素。Hosmer-Lemeshow拟合检验的结果无统计学意义(P <0. 566),表明在预测和观察的概率具有较高的一致性,ROC曲线下面积达到0. 773(95%CI:0. 734-0. 812)。结论胸段食管鳞癌患者的淋巴结转移与患者性别、病理T分期、肿瘤分化程度和是否存在脉管浸润密切相关。从而可以建立淋巴结转移预测模型,以帮助临床医生制订个体化手术方案。

Objective To investigate the risk factors of lymph node metastasis in thoracic esophageal squamous cell carcinoma and establish a predictive model.Methods Retrospective analysis of the clinicopathological data of 628 patients whose clinic pathological stage ranged from IA to IVA were undergone esophageal cancer resection from January 2013 to December 2016 at the First Affiliated Hospital of Zhengzhou University.Among them, patients were between 28 and 82 years old, 394 were male, and 234 were female. There were 165 cases with right thoracic open surgery and 463 cases of thoracoscopic surgery, all of which were performed with the UICC guidelines for systematic lymph node dissection. The correlation between lymph node metastasis and risk factors was analyzed with Student’s t-test and χ 2- test, and Logistic regression multifactor analysis was performed to establish predictive model.Results Several risk factors of the lymph node metastasis were found in our study： Gender （χ 2=11.135, P =0.001）, cigarette smoking（χ 2=10.325, P =0.008）,alcohol consumption（χ 2=7.137, P = 0.001）, pT stage（χ 2=75.733, P =0.001）, G stage（χ 2=60.261, P =0.001） and vascular invasion （χ 2=35.092, P =0.001）. Moreover , multivariate analysis showed that male, histological T staging, tumor differentiation and vascular invasion were independent risk factors for lymph node metastasis of thoracic esophageal squamous cancer. The results of Hosmer-Lemeshow fit test were not statistically significant （ P 〈0.566）, indicating a high consistency in the probability of prediction and observation. The area under the ROC curve reached 0.773 （95% CI： 0.734-0.812）.Conclusion The pathological T stage,agender, tumor differentiation, and whether there existed vascular invasion were closely related to the Lymph node metastasis in patients with thoracic esophageal squamous cell carcinoma. Thus we can establish a prediction model for lymph node metastasis so that clinicians can easily perform individualized surgical treatment.