临床T2N0M0食管鳞癌患者病理分期上升的影响因素

Risk Factors of Pathological Upstaging for Patients with Clinical T2N0M0 Esophageal Squamous Cell Carcinoma

目的通过对临床T2N0M0食管鳞癌患者临床病理资料的分析,探讨患者术后病理分期上升的影响因素。方法收集149例术前诊断为临床T2N0M0食管鳞癌并行胸腹腔镜下根治性手术切除患者的临床资料,采用多变量Logistic回归分析分析各临床病理因素对患者病理分期上升的影响。结果病理诊断T2N0M0患者59例,准确率为39.6%。15.4%病理分期下降,45%病理分期上升。28.2%病理T分期上升;30.2%患者发生淋巴结转移;12.8%患者同时存在T分期上升和淋巴结转移。单变量分析结果显示,T分期上升的影响因素为肿瘤长度、浸润深度、大体病理类型和分化程度,淋巴结转移的影响因素为肿瘤长度、浸润深度(P<0.05)。多变量分析结果显示,T分期上升的影响因素为肿瘤长度、浸润深度和分化程度;淋巴结转移的影响因素为肿瘤长度、分化程度和病变位置(P<0.05)。结论T2N0M0食管鳞癌患者临床分期仍不准确。肿瘤长度、浸润深度和分化程度是T分期升高的危险因素,而影响淋巴结转移的因素为肿瘤长度、分化程度和病变部位。

Objective To investigate the risk factors for pathological upstaging of clinical T2N0M0 esophageal carcinoma by analyzing the clinicopathological data. Methods We collected 149 patients with clinical T2N0M0 esophageal squamous carcinoma who underwent minimally invasive esophagectomy with two-field lymph node dissection. Univariate and multivariate Logistic regression analyses were performed to identify the factors related to pathologic upstaging. Results There were 59 (39.6%) cases of pathologic T2N0M0;23(15.4%) cases were downstaged;67(45%) cases were upstaged;42(28.2%) cases were pathological T upstaged;and 45(30.2%) cases had lymph node metastasis. Both T upstaging and lymph node metastasis occurred in 12.8% patients. Univariate analysis showed that tumor length, depth of infiltration, differentiation degree and pathological morphology were related to T upstaging and the influencing factors of lymph node metastasis were tumor length and depth of infiltration (P<0.05). Multivariate analysis revealed that tumor length, depth of infiltration and differentiation degree were risk factors for T upstaging and the factors influencing lymph node metastasis were tumor length, degree of differentiation and lesion location (P<0.05). Conclusion Clinical staging of T2N0M0 esophageal cancer remains inaccurate. Tumor length, depth of infiltration and differentiation degree are risk factors for T upstaging. The factors influencing lymph node metastasis are tumor length, degree of differentiation and lesion location.