食管中下段鳞癌颈部淋巴结转移的危险因素分析及诊断模型构建

Analysis of risk factors for cervical lymph node metastasis in middle and lower esophageal squamous cell carcinoma and construction of a diagnostic model

目的:探讨食管中下段鳞癌颈部淋巴结转移的危险因素并构建诊断模型,为临床选择合理手术方式提供参考。方法:选取2015年1月至2020年6月于河北医科大学第四医院行食管癌根治术+三野淋巴结清扫的240例食管中下段鳞癌患者作为观察对象,依据术后病理分为颈部淋巴结转移组和颈部淋巴结无转移组。采用多因素Logistic回归分析颈部淋巴结转移的独立危险因素,并建立诊断模型,应用受试者工作特征(ROC)曲线评估其诊断效能。结果:240例食管中下段鳞癌患者中有62例(25.8%)发生颈部淋巴结转移。Logistic回归分析结果显示,肿瘤最大径、食管旁淋巴结转移、喉返神经旁淋巴结转移和CT诊断颈部淋巴结转移是食管中下段鳞癌颈部淋巴结转移的独立危险因素。诊断模型为P=1/(1+exp(-(-3.764+0.361×肿瘤最大径+1.281×食管旁淋巴结转移+1.614×喉返神经旁淋巴结转移+1.155×CT诊断颈部淋巴结转移))),其阴性预测值为89.89%,阳性预测值为45.16%,准确度为78.33%。ROC曲线分析显示,ROC曲线下的面积为0.827(95%CI:0.767~0.886),约登指数为0.530,灵敏度和特异度分别为70.97%和82.02%。结论:肿瘤最大径、食管旁淋巴结转移、喉返神经旁淋巴结转移和CT诊断颈部淋巴结转移是食管中下段鳞癌颈部淋巴结转移的独立危险因素,以此为基础建立的诊断模型具有一定的临床运用价值。

Objective:To investigate the risk factors of cervical lymph node metastasis in middle and lower esophageal squamous cell carcinoma and construct a diagnostic model to provide clinical strategies for the rational selection of surgical methods.Methods:A total of 240 patients with middle and lower esophageal squamous cell carcinoma,who underwent radical esophagectomy and three-field lymph node dissection at The Fourth Hospital of Hebei Medical University from January 2015 to June 2020 were selected as the observation subjects.According to the postoperative pathology,the patients were assigned into the cervical lymph node metastasis group and non-cervical lymph node metastasis group.Multivariate Logistic regression was used to analyze the independent risk factors of cervical lymph node metastasis,and receiver operating characteristic(ROC)curve was used to evaluate the diagnostic performance.Results:Among 240 patients,62(25.8%)had cervical lymph node metastasis.Multivariate Logistic regression analysis revealed that the largest tumor diameter,paraesophageal lymph node status,recurrent laryngeal nerve lymph node status,and cervical lymph node metastasis status diagnosed by computed tomography(CT)were independent risk factors for cervical lymph node metastasis in middle and lower esophageal squamous cell carcinoma.The diagnostic model:P=1/(1+exp(-(-3.764+0.361×largest tumor diameter+1.281×paraesophageal lymph node status+1.614×recurrent laryngeal nerve lymph node status+1.155×cervical lymph node metastasis status diagnosed by CT))).The negative and positive predictive values were 89.89%and 45.16%,respectively.The area under the ROC curve of the diagnostic model constructed according to the independent risk factors was 0.827(95%CI:0.767–0.886),and the Youden index was 0.530,corresponding to a sensitivity and specificity of 70.97%and 82.02%,respectively.Conclusions:The largest tumor diameter,paraesophageal lymph node status,recurrent laryngeal nerve lymph node status,and cervical lymph node metastasis status diagnosed by CT are independent risk factors for cervical lymph node metastasis of middle and lower esophageal squamous cell carcinoma.The diagnostic model established on this basis has a certain clinical application value.