饮酒模式与下咽癌伴发第二原发性食管癌的关系

Relationship of alcohol consumption patterns and hypopharyngeal carcinoma with second primary esophageal cancer

目的分析下咽鳞状细胞癌(HSCC)患者伴发第二原发性食管癌(SPEC)的危险因素,为SPEC的监测提供临床依据。方法选取2017-01-01-2020-12-31山东省耳鼻喉医院头颈外科诊治的185例HSCC患者为研究对象,回顾患者在院治疗及治疗后随访期间电子胃镜及胃镜下活检病理结果,根据有无伴发SPEC分为伴SPEC组、无SPEC组,比较两组患者5年总生存率及饮酒模式差异,并探寻可能相关的危险因素。应用Kaplan-Meier法、假设检验、单因素和多因素非条件logistic回归等方法进行统计学分析。结果伴SPEC组与无SPEC组患者5年总生存率分别为39.8%和50.2%,P=0.198。多因素非条件logistic回归分析显示:在频繁饮酒的HSCC患者中,日均饮酒量(P=0.022,OR=1.111,95%CI:1.015~1.216)、空腹饮酒(P=0.019,OR=2.971,95%CI:1.196~7.378)及原发于下咽后壁的HSCC(P=0.009,OR=3.786,95%CI:1.399~10.249)是伴发SPEC的危险因素,该logistic回归模型预测HSCC伴发SPEC的曲线下面积为0.765。结论在频繁饮酒的HSCC患者中,日均饮酒量更大、喜好空腹饮酒、HSCC原发灶位于下咽后壁的患者更易伴发SPEC。有必要对上述HSCC患者进行SPEC监测。

Objective To analyze the risk factors for the occurence of second primary esophageal cancer(SPEC)in patients with hypopharyngeal squamous cell carcinoma(HSCC),and to provide a clinical basis for SPEC monitoring.Method A total of 185 cases of HSCC treated in the Department of Head and Neck Surgery,Shandong Provincial ENT Hospital from January 1,2017 to December 31,2020 were included in this study.A retrospective analysis was performed on the electronic gastroscopy and gastroscopic biopsy results during hospitalization and the follow-up period.The patients were divided into two groups,namely the SPEC and SPEC-free groups,based on whether they had concomitant SPEC.The 5-year overall survival rates and differences in alcohol consumption patterns between the two groups were compared,and potential risk factors were explored.Statistical analysis was performed using Kaplan-Meier,hypothesis tests and univariate/multivariate unconditional logistic regression models.Results The 5-year overall survival rates of SPEC and SPEC-free groups were 39.8%and 50.2%,respectively(P=0.198).The multivariate unconditional logistic regression analysis showed that higher average daily alcohol intake(P=0.022,OR=1.111,95%CI:1.015-1.216),drinking on an empty stomach(P=0.019,OR=2.971,95%CI:1.196-7.378),and HSCC originating from the posterior wall of the hypopharynx(P=0.009,OR=3.786,95%CI:1.399-10.249)were risk factors for SPEC in HSCC patients with frequent alcohol consumption.The area under the curve of this logistic regression model predicting HSCC with concomitant SPEC was 0.765.Conclusion HSCC patients with frequent alcohol consumption are at higher risk of developing concomitant SPEC in cases of higher average daily alcohol intake,drinking on an empty stomach,and primary lesions located in the posterior wall of the hypopharynx.SPEC monitoring is necessary for patients with these characteristics.