pT_(2)N_(0)M_(0)期胸段食管鳞癌术后局部复发预测模型的建立和分析

Establishment and Analysis of the Model for Predicting Local Recurrence of pT_(2)N_(0)M_(0) Thoracic Esophageal Squamous Cell Carcinoma

目的:探讨影响pT_(2)N_(0)M_(0)期胸段食管鳞癌术后局部复发的相关因素并建立数学预测模型.方法:收集行手术治疗的213例pT_(2)N_(0)M_(0)期胸段食管鳞癌患者的临床病理资料进行回顾性分析.胸腔内区域复发与各变量间的单因素分析采用卡方检验,多因素分析采用Logistic回归分析筛选影响复发的独立性因素,并建立数学预测模型,ROC曲线分析评价其临床诊断性能.结果:全组出现胸腔内区域复发54例,复发率为25.35%;远处转移27例,远处转移率为12.67%.单因素分析显示胸腔内区域复发与患者的术前进食情况、病变部位和组织分化程度等有关(χ2=5.171,P=0.023;χ2=6.255,P=0.044;χ2=4.499,P=0.034);多因素分析结果显示术前进食情况和病变部位为影响患者胸腔内区域复发的独立性危险因素(P=0.025,P=0.016).在此基础上建立的胸腔内区域复发的预测模型为Y=ex/(1+ex),其中X=0.297+0.821×疗前进食情况变量赋值-0.761×病变部位变量赋值.建立模型ROC曲线下的面积为0.859(95%CI:0.794~0.925),对应的预测敏感度为77.83%,特异度为89.32%.Cox多因素分析结果显示影响患者出现胸腔内区域复发的独立性危险因素为组织分化程度和数学预测模型所计算的预测值(P=0.021,P=0.003).结论:术前进食情况和病变部位为影响pT_(2)N_(0)M_(0)期胸段食管鳞癌术后患者出现胸腔内区域复发的独立性危险因素,建立的数学预测模型对这类患者胸腔内区域复发的发生有较好的预测价值.

Objective: To investigate factors affecting local recurrence of pT_(2)N_(0)M_(0) thoracic esophageal squamous cell carcinoma(TESCC), and establish a mathematical prediction model.Methods:Clinicopathological data of 213 pT_(2)N_(0)M_(0) TESCC patients who underwent surgical treatment were collected for retrospective analysis. Chi-square test was used for univariate analysis of intrathoracic recurrence, and multivariate logistic regression analysis was used to screen independent factors affecting recurrence. And a mathematical prediction model was established to draw the ROC curve and evaluate the performance of the model in clinical diagnosis. Results: Intrathoracic recurrence occurred in 54 cases, with the recurrence rate of 25.35%;distant metastasis occurred in 27 cases, with the distant metastasis rate of 12.67%. Univariate analysis showed that intrathoracic recurrence was associated with preoperative food intake, lesion sites and tissue differentiation(χ^(2)=5.171, P=0.023;χ^(2)=6.255, P=0.044;χ^(2)=4.499, P=0.034);multivariate analysis showed that preoperative food intake and lesion sites were independent risk factors for recurrence(P=0.025, P=0.016). The predictive model of intrathoracic recurrence established on this basis was Y=ex/(1+ex), where X=0.297+0.821×the assigned value of preoperative food intake-0.761×the assigned value of lesion site. AUC was 0.859(95%CI: 0.794~0.925), with sensitivity of 77.83% and specificity of 89.32%. Cox analysis showed that independent risk factors affecting intrathoracic recurrence were degree of differentiation and predicted values calculated by the mathematical prediction model(P=0.021, P=0.003). Conclusion: Preoperative food intake and lesion sites are independent risk factors for intrathoracic recurrence in pT2N0M0 TESCC patients. The mathematical prediction model has good predictive value for incidence of intrathoracic recurrence in these patients.