农村与城市、低发区与高发区食管鳞癌患者淋巴结转移对比分析

Lymph Node Metastasis in the Patients with Esophageal Squamous Cell Carcinoma in the Rural Area and Ruban Area,Low Incidence Area and High Incidence Area

目的对比分析农村与城市、低发区与高发区食管癌患者淋巴结转移的特征。方法 58 503例食管鳞癌患者均来自郑州大学河南省食管癌重点开放实验室1973年至2015年50万例食管癌和贲门癌临床信息数据库。采用χ2检验和多因素Logistic回归分析淋巴结转移影响因素。结果 58 503例食管鳞癌患者中,男37 338例,年龄（59±9）岁;女21 165例,年龄（60±9）岁。农村患者淋巴结阳性率高于城市患者（39.3%vs 37.3%,P=0.011）,低发区患者淋巴结阳性率明显高于高发区患者（40.0%vs 38.6%,P=0.001）,男性患者淋巴结转移阳性率明显高于女性患者（40.8%vs 36.2%,P=0.000）。依淋巴结转移阳性数,将患者分为4组（N0:0枚,N1:13枚,N2:46枚,N3:>7枚）,男性患者淋巴结转移阳性率均高于女性患者（N1:24.0%vs 23.0%,N2:13.2%vs 10.8%,N3:3.2%vs 2.4%;P<0.001）,低发区患者淋巴结转移阳性率也明显高于高发区（P<0.001）,但农村和城市患者淋巴结转移阳性率相似。多因素Logistic回归分析显示:男性[OR=1.212,P<0.001,95%CI（1.7171.255）]、低发区[OR=1.057,P=0.002,95%CI（1.0211.094）]和农村[OR=1.108,P=0.002,95%CI（1.0391.182）]是淋巴结转移的危险因素。结论低发区、农村、男性患者是食管癌发生淋巴结转移的危险因素。

Objective To compare and analyze the characteristics of lymph node metastasis in the patients with esophageal squamous cell carcinoma in the rural area and ruban area,low incidence area and high incidence area.Methods A total of 58 503 patients with esophageal squamous cell carcinoma were enrolled from 50 thousands esophageal and cardia tumor database of Henan Key Laboratory for Esophageal Cancer Research( 1973- 2015) in the First Affiliated Hospital of Zhengzhou University. Chi square test and multiple factor Logistic regression analysis were used for analyzing influential factors of lymph node metastasis. Results In these 58 503 patients,male 37 338 patients,with an average age of( 59 ± 9),female 21 165 patients,with an average of 60 ± 9. The positive rate of lymph node metastasis in the rural patients was superior to the ruban patients( 39. 3% vs 37. 3%,P = 0. 011),in the low incidence area was significantly higher than in the high incidence area( 40. 0% vs 38. 6%,P = 0. 001),and male patients were superior than female( 40. 8% vs 36. 2%,P < 0. 001). According to the positive number of lymph node metastasis,all the patients were divided into four groups( N0: 0; N1: 1-3,N2: 4-6,N3: more than 7),the positive rate of lymph node metastasis in the male patients was higher than that in the female( N1: 24. 0% vs 23%,N2:13. 2% vs 10. 8%,N3: 3. 2% vs 2. 4%; P < 0. 001). The positive rate of lymph node metastasis in low incidence area was significantly higher than that in high incidence area( P < 0. 001),but was similar in the rural area and urban area. Multi factor Logistic regression analysis showed that male [OR = 1. 212,P < 0. 001,95% CI( 1. 717 ~1. 255) ],low incidence area [OR = 1. 057,P = 0. 002,95% CI( 1. 021 ~ 1. 094) ] and rural [OR = 1. 108,P =0. 002,95% CI( 1. 039 ~ 1. 182) ] were the risk factors of lymph node metastasis. Conclusion Low incidence area,rural area and male are the risk factors of lymph node metastasis in the patients with esophageal squamous cell carcinoma.