Ⅱ/Ⅲ型胃食管结合部腺癌淋巴结转移的危险因素及随访分析

Assessment of risk factors of lymph node metastasis and follow-up of SiewertⅡ/Ⅲadenocarcinoma of esophagogastric junction

目的探讨Ⅱ/Ⅲ型胃食管结合部腺癌(AEG)淋巴结转移危险因素及术后随访情况。方法回顾性分析2013年6月—2019年12月在首都医科大学附属北京友谊医院接受手术的134例AEG患者临床资料,其中,男性112例,女性22例,男女比例为5.1∶1;年龄27~82岁,平均年龄62.1岁。主要研究指标为淋巴结转移危险因素和3年总体生存率,次要研究指标为淋巴结转移率和淋巴结转移分布情况。随访方式主要以门诊、电话等方式开展。随访期间,患者需要接受体格检查,实验室检查,胸、腹部CT检查以及每年进行1次胃镜检查,评估疾病情况,随访期至2020年1月。计数资料组间比较采用χ2检验或Fisher确切概率法,等级资料进行组间比较采用秩和检验。逐步法Logistic回归进行多因素分析,COX回归风险模型进行生存分析。结果多因素分析显示肿瘤浸润深度(OR=4.341,95%CI:2.498~7.545,P=0.000)、肿瘤大体类型(OR=3.626,95%CI:1.425~9.228,P=0.007)及脉管内癌栓(OR=2.888,95%CI:1.106~7.544,P=0.030)与淋巴结转移密切相关。Ⅱ/Ⅲ型AEG患者均易出现腹腔淋巴结转移,其中以第1、2、3、4、7、11组淋巴结为主。Ⅲ型AEG患者易出现第5、6组淋巴结转移,而其在Ⅱ型AEG中转移率低。与Ⅲ型AEG相比,Ⅱ型AEG易出现纵隔淋巴结转移,其中以第110和111组淋巴结为主,转移率分别为7.1%和3.0%。3年随访发现无淋巴结转移(82.1%比46.1%,P=0.046)和接受辅助化疗(60.6%比39.4%,P=0.007)的患者,术后生存期显著延长,差异有统计学意义。结论肿瘤浸润深度、肿瘤大体类型和脉管内癌栓是影响AEG淋巴结转移的独立危险因素。对于合并有淋巴结转移的AEG患者远期预后差,但是辅助化疗可以在一定程度上延长患者的生存时间。

Objective To explore the risk factors of lymph node metastasis and prognosis in SiewertⅡ/Ⅲadenocarcinoma of esophagogastric junction(AEG)patients.Methods A total of 134 patients who underwent surgical operation between June 2013 and December 2019 at the Beijing Friendship Hospital,Capital Medical University were retrospectively reviewed,including 112 males and 22 females,with a male to female ratio of 5.5∶1 and an average age of 62.1(27-82 years old).The primary outcomes were lymph node metastasis risk and 3-years overall survival.The secondary outcomes were the rate and pattern of lymph node metastasis.Follow-up methods mainly include outpatient and telephone.During the follow-up period,the patient needs to receive physical examination,laboratory examinations,chest and abdominal CT scan and gastroscopy to evaluate the status of disease.The patients were followed up until January 2020.Chi-square test or Fisher test was used for the comparison between count data group,and rank sum test was used for the comparison between grade data group.Stepwise Logistic regression was used for multivariate analysis,and COX regression risk model was used for survival analysis.Results Multivariate analysis revealed that the parameters infiltration depth(OR=4.341,95%CI:2.498-7.545,P=0.000),gross type(OR=3.626,95%CI:1.425-9.228,P=0.007)and intravascular cancer embolus(OR=2.888,95%CI:1.106-7.544,P=0.030)correlated with lymph node metastasis.For all patients,the lymph nodes No.1,2,3,4,7,11 indicated higher lymph node metastatic rate in the abdominal cavity.However,No.5 and No.6 indicated different tendency,which was higher in SiewertⅢAEG and lower in SiewertⅡAEG patients.Mediastinal lymph node metastasis of SiewertⅡAEG mainly occurred in No.110 and No.111 cases corresponding to 7.1 and 3.0%,respectively,compared with those noted in SiewertⅢAEG patients.The 3-year overall survival analysis revealed that lymph node metastasis(82.1%vs 46.1%,P=0.046)and chemotherapy(60.6%vs 39.4%,P=0.007)exhibited significant differences.Conclusions The infiltration depth,gross type and intravascular cancer embolus are independent risk factors of lymph node metastasis.In addition,patients with lymph node metastasis exhibite worse long-term prognosis.The data indicate that perioperative chemotherapy could improve the prognosis of AEG patients.