基于计算机断层扫描的淋巴结轴比预测食管鳞癌淋巴结转移

Prediction of lymph node metastasis in esophageal squamous cell carcinoma based on lymph node axis ratio by computed tomography

目的探讨基于计算机断层扫描(CT)的淋巴结轴比预测食管鳞癌淋巴结转移的价值。方法选取2019年7月至2022年12月郑州大学第一附属医院胸外科收治的胸段食管鳞癌患者204例,回顾性分析术前CT检查结果,分别收集第106recR组右喉返淋巴结、第106recL组左喉返淋巴结、第107组隆突下淋巴结、第1组贲门右淋巴结、第7组胃左动脉淋巴结区域中代表性淋巴结的短轴与长轴直径,并计算轴比,以进行最佳诊断标准分析。结果各组诊断淋巴结转移的最佳轴比截断值分别为:第106recR组0.76[曲线下面积(AUC)=0.89,P<0.001],第106recL组0.89(AUC=0.82,P<0.001),第107组0.81(AUC=0.92,P<0.001),第1组0.87(AUC=0.84,P=0.004),第7组0.84(AUC=0.93,P<0.001)。其中第7组胃左动脉淋巴结轴比标准诊断良性与转移性淋巴结效能最好,淋巴结状态能够得到更准确评估(敏感性93.3%,特异性87.7%,约登指数0.81,阳性预测值66.7%,P<0.001)。结论食管鳞癌患者不同区域淋巴结用于预测转移的最佳淋巴结轴比标准不同,分析这些差异有助于制定合适的治疗方案和确定淋巴结清扫范围。

Objective To prediction values of lymph node metastasis in esophageal squamous cell carcinoma based on lymph node axis ratio by computed tomography(CT).Methods A total of 204 patients with esophageal squamous cell carcinoma of the thoracic segment admitted to the Department of Thoracic Surgery of the First Affiliated Hospital of Zhengzhou University from Jul 2019 to Dec 2022 were selected,and the preoperative CT findings were analyzed retrospectively.The short-axis and long-axis diameters of representative lymph nodes in the following groups of lymph node regions were collected separately,and the axis ratios were calculated.Included the 106recR group right recurrent laryngeal lymph node,the 106recL group left recurrent laryngeal lymph node,the 107 group subcarinal lymph node,the 1 group right cardiac lymph node,the 7 group left gastric arterial lymph node.Finally,the best diagnostic criteria were analyzed.Results The best axial ratio cut-off values for the diagnosis of metastasis in each group of lymph nodes were 0.76[area under the curve(AUC)=0.89,P<0.001]for the 106recR group,0.89(AUC=0.82,P<0.001)for the 106recL group,0.81(AUC=0.92,P<0.001)for the 107 group,0.87(AUC=0.84,P=0.004)for the 1 group,and 0.84(AUC=0.93,P<0.001)for the 7 group.Among them,the axial standard of the 7 group left gastric arterial lymph node had the best diagnostic efficacy to distinguish between benign and metastatic lymph nodes,and the status of lymph nodes could be evaluated more accurately(the sensitivity of 93.3%,the specificity of 87.7%,the Youden index of 0.81,the positive predictive value of 66.7%,P<0.001).Conclusion The optimal lymph node axis ratio standards for predicting metastasis vary in different regions of esophageal squamous cell carcinoma,analyzing these differences can help develop appropriate treatment plans and determine the scope of lymph node dissection.