pT3N0M0期胸段食管鳞癌根治术后的预后因素

目的 探讨pT3N0M0期胸段食管鳞癌两野根治术后的预后及其影响因素。方法 胸段食管鳞癌行胸腹两野食管癌根治术后、分期为pT3N0M0者249例,中位年龄60岁（33~78岁）;胸上段39例、胸中段166例、胸下段44例,病变中位长度5 cm（2~12 cm）;术中无粘连者35例、轻度粘连者90例、重度粘连者124例;术中清扫淋巴结中位数9枚（1~27枚）;98例单纯手术、151例行术后辅助治疗。结果 249例中1、3、5年总生存率（overall Survival, OS）和无进展生存率（progression-free survival, PFS）分别为90.0%、68.7%、55.2%和82.1%、61.7%、5 3 . 9%。单因素分析结果显示：性别、肿瘤位置、病理分化程度和术前血红蛋白水平与O S 有关（P<0.05）;年龄、肿瘤位置和术中粘连程度与PFS有关（P<0.05）;多因素分析结果显示：肿瘤位置、术前血红蛋白水平、术前CT有纵隔小淋巴结（<1 cm）和清扫淋巴结数目是OS独立影响因素,肿瘤位置是影响PFS独立危险因素。术后辅助治疗对OS和PFS均无明显影响;但术前CT纵隔有小淋巴结（<1 cm）者,术后辅助治疗可以提高OS和PFS（P<0.05）。结论 pT3N0M0期胸段食管鳞癌胸腹两野根治术后,肿瘤位置影响OS和PFS,胸下段癌预后最好,胸上段癌预后最差;术中清扫淋巴结数多、术前CT纵隔无淋巴结者预后较好,反之预后较差;术前血红蛋白高者生存率低;而术后辅助治疗的价值有待证实。     

阳性淋巴结对数比对食管鳞癌患者术后生存期的影响

摘 要：［目的］ 探讨阳性淋巴结对数比（log odds of positive lymph nodes,LODDS）对食管鳞癌（esophageal squamous cell carcinoma,ESCC）患者,特别是淋巴结转移阴性患者术后生存期的影响,为淋巴结转移精准分期提供依据。［方法］ 5077例行食管癌根治术的ESCC患者（1976～2015年）均来自郑州大学第一附属医院河南省食管癌重点开放实验室50万例食管癌和贲门癌临床信息数据库。采用Cox多因素回归模型进行多因素分析,Log-rank法比较组间生存率;使用受试者工作特征曲线（receiver operating characteristic curve,ROC曲线)和曲线下面积（area under curve,AUC）比较pN分期和LODDS分期系统的预后评价能力。截点值分析探讨是否有一个最佳LODDS截点值使生存差异最大。［结果］ 对于淋巴结转移阴性ESCC患者,LODDS最佳的截点值是-1.2（即淋巴结取材数目为8枚）,LODDS小于-1.2（即淋巴结取材数目为8枚以上）时,其与淋巴结转移阴性ESCC患者预后明显相关（χ2=4.780,P=0.029）,且ROC曲线分析也显示LODDS的最佳截点值为-1.2时约登指数最大。LODDS分期的AUC大于pN分期（0.632 vs 0.610,P<0.001）。多因素Cox回归分析显示：性别（HR=0.863,P<0.001）、年龄（HR=1.295,P=0.008）、家族史（HR=0.912,P=0.016）、肿瘤部位(HR=0.863,P<0.001)、分化程度(HR=0.849,P<0.001)、T分期(HR=1.190,P=0.011)、LODDS分期(HR=1.080,P=0.008)是食管鳞癌患者的独立预后影响因素。［结论］ LODDS定量分析对淋巴结转移阴性的ESCC患者的预后判断有一定意义,淋巴结取材数目8枚以上（LODDS小于-1.2）的患者预后较好,提示对淋巴结转移阴性ESCC患者淋巴结清扫数目应为8枚以上;LODDS是影响ESCC患者的独立预后影响因素。     

阳性淋巴结对数比(LODDS)对食管鳞癌左胸入路根治术后pN0期患者预后的预测价值

目的 探讨阳性淋巴结对数比(LODDS)在预测食管鳞癌左胸入路根治术后pN0期患者预后中的临床价值。方法 回顾性分析80例食管鳞癌患者临床资料。所有患者均行左胸入路食管癌根治术+淋巴结清扫术治疗,送检标本计算LODDS;绘制ROC曲线分析LODDS在预测食管鳞癌术后pN0期患者预后的临床价值,并依据LODDS最佳截点值分组,统计患者预后生存情况;收集所有患者年龄、性别、体质量指数、病变位置、分化程度、肿瘤分期、肿瘤直径、LODDS等多方面资料,采用COX回归分析获得食管鳞癌术后pN0期患者预后的独立危险因素。结果 全组患者LODDS中位数为-1.35(-2.02～0.53),当LODDS处于-1.23时约登指数(1.212)最大,以-1.23为最佳截点预测患者预后的灵敏度为0.785,特异度为0.512,曲线下面积(AUC)为0.627(P=0.045);80例患者随访3年,存活率为81.25%(65/80);依据-1.23分为>-1.23组(42例)与≤-1.23组(38例),其中≤-1.23组存活率为92.11%(35/38),高于>-1.23组的71.43%(30/4...     

阳性淋巴结对数比(LODDS)对食管鳞癌左胸入路根治术后pN0期患者预后的预测价值

目的:探讨阳性淋巴结对数比（LODDS）对食管鳞癌左胸入路根治术后pN0期患者预后的预测价值。方法:回顾性分析2005年01月至2014年12月期间在我院胸外科行左胸入路的食管癌根治术,且术后病理类型为鳞癌,病理分期为N0期的336例患者的临床、病理及随访资料,分析LODDS对该组患者预后的影响及其判断预后的最佳截点值,应用SPSS 19.0软件进行统计学分析。结果:ROC曲线分析显示,当LODDS以-1.278为最佳截点值时,其约登指数最大,预测患者预后效果最好。将全组患者的LODDS值以-1.278分为≤-1.278组和＞-1.278组,两组患者1、3、5年生存率分别为92.3%、82.1%、75.0%和86.1%、62.6%、52.6%,差异有显著性（χ2=19.241,P=0.000）。全组患者1、3、5年生存率分别为89.5%、71.7%和63.0%。COX多因素分析结果显示,患者年龄、pT分期和LODDS为影响其生存的独立性因素。结论:本研究结果显示,LODDS为胸段食管鳞癌左胸入路根治术后pN0期患者预后的独立性影响因素,且 LODDS≤－1.278的患者具有较好的预后。本研究结果尚需多中心、大样本的临床研究进一步证实。     

胸段食管鳞癌颈部淋巴结转移特点及其临床意义

背景与目的：食管癌颈部淋巴结转移率较高,但少有专门报道。本研究分析胸段食管鳞癌颈部淋巴结转移特点,探讨其临床意义。方法：选择1993年1月—2003年12月在福建省肿瘤医院行胸段食管鳞癌三野淋巴结清扫根治术患者1 131例,对术后病理证实颈部淋巴结转移患者376例的具体情况进行分析。结果：全组颈部淋巴结转移率为33.2%,其中胸上、中及下段的颈部淋巴结转移率分别为43.7%、33.0%和16.0%。单因素分析显示,颈部淋巴结转移率与肿瘤部位、病理分化程度、病变X线长度、pT分期以及淋巴结转移个数有关(P<0.05),但多因素回归分析显示,颈部淋巴结转移率只与肿瘤部位、pT分期及淋巴结转移个数有关(P<0.05)。颈段食管旁淋巴结转移最多见,其次是锁骨上淋巴结转移,颈深淋巴结及咽后淋巴结转移少见;胸上、中及下段的颈部淋巴结转移数占该段淋巴结总转移数的比率分别为57.7%、32.0%和10.0%,差异有统计学意义(P<0.05);各段食管癌右颈部淋巴结转移多于左颈部。结论：影响胸段食管鳞癌颈部淋巴结转移独立因素是肿瘤部位、pT分期及淋巴结转移数;颈段食管旁淋巴结转移最多见,其次是锁骨上淋巴结转移,颈深淋巴结及咽后淋巴结转移少见。     

339例中晚期胸段食管鳞癌术后生存评价及预后因素分析

目的探讨影响中晚期胸段食管鳞癌患者术后生存和预后的因素。方法采用COX比例风险模型回顾性分析新疆肿瘤医院行胸段食管癌根治术339例病例的临床资料。结果中晚期胸段食管鳞癌患者总1、3、5年生存率分别为80.49%、41.94%、23.12%,单因素分析显示体重减轻、血红蛋白水平、术前白蛋白水平、淋巴结转移个数、侵润深度、术后病理分期、脉管瘤栓与生存时间有关（P〈0.05）;多因素分析显示肿瘤侵润深度、淋巴结转移个数、术后病理分期、术前白蛋白水平是影响中晚期胸段食管鳞癌预后的独立因素。结论肿瘤侵润深度、淋巴结转移个数、术后病理分期、术前白蛋白水平是影响中晚期胸段食管鳞癌患者术后生存的独立因素。     

pT4期食管癌患者术后疗效分析北大核心CSCD

目的回顾性分析p T4期食管癌患者术后的疗效及其影响因素。方法收集77例pT4N0~3M0期食管癌患者术后资料;采用Cox单因素和多因素法分析其术后疗效和影响因素。结果至随访期结束,全组术后3、5年生存率和中位生存期(OS)分别为39.0%、35.3%和24月;单因素分析,病变部位和pN分期与OS有关(P<0.05),Cox多因素分析发现仅pN分期是影响OS的独立危险因素。全组术后3、5年无进展生存率和中位无进展生存期(PFS)分别为43.6%、34.6%和21月;单因素分析发现病变部位和pN分期与PFS有关(P<0.05);Cox多因素分析发现pN分期和清扫淋巴结数目是影响PFS的独立危险因素。结论 pT4期食管癌术后疗效不佳,pN分期是预后独立危险因素,分期越晚、预后越差;病变部位也影响疗效。     

Ⅱ、Ⅲ期胸段食管鳞癌术后不同辅助治疗方式的疗效分析

目的 评价术后联合放化疗(S+CRT)或术后放疗(S+RT)对Ⅱ、Ⅲ期胸段食管鳞癌患者疗效和不良反应。方法 收集2007—2010年间行根治术且术后辅助放疗或放化疗的Ⅱ、Ⅲ期胸段食管鳞癌215例患者资料。Kaplan-Meier法计算生存率并Logrank法检验和单因素预后分析,Cox模型多因素预后分析。结果 S+CRT与S+RT组资料具有可比性(P=0.055~0.988)。随访满1、3、5年者分别为203、133、108例。全组患者1、3、5年OS和DFS分别为94.0%、61.4%、49.3%和74.9%、53.5%、46.7%。患者术前CT显示纵隔淋巴结肿大、术中食管病变与周边组织器官粘连程度、病理N分期、脉管瘤栓、阳性淋巴结个数和治疗方式均为OS影响因素(P=0.000~0.034),患者术前CT显示纵隔淋巴结肿大、术中食管病变与周边组织器官粘连程度、术后残端是否阳性、阳性淋巴结个数和治疗方式均为DFS影响因素(P=0.000~0.049)。S+CRT组OS、DFS均优于S+RT组(P=0.002、0.002)。分层分析显示Ⅱ期患者S+CRT组OS、DFS均高于S+RT组(P=0.041、0.001);N₁期患者S+CRT组OS、DFS也均高于S+RT组(P=0.021、0.024)。S+CRT组≥2级放射性胃炎及骨髓抑制发生率均高于S+RT组(P=0.000、0.015)。结论 Ⅱ、Ⅲ期胸段食管鳞癌术后患者接受S+CRT及S+RT均具有较好疗效;S+CRT较S+RT能提高Ⅱ期和N₁期患者OS与DFS;S+CRT组不良反应较大但患者均可耐受;但最终结论需前瞻性Ⅲ期随机研究证实。     

胸中段食管鳞癌根治术后腹腔淋巴结复发因素分析及术后放疗指导意义

目的 分析胸中段食管鳞癌根治术后腹腔淋巴结复发危险因素,并依据结果讨论术后放疗靶区设计方案。方法 对2007—2012年间收治的 913例胸中段食管鳞癌根治性术后患者进行回顾分析,分析影响患者治疗后出现腹腔淋巴结复发的因素,并比较高危人群不同治疗方式的疗效。对计数资料行χ²检验,Kaplan-Meier法计算OS并Logrank单因素分析,Logistic多元回归方程分析与腹腔淋巴结复发相关影响因素。结果 疗后 37例出现腹腔淋巴结复发,复发率为4.1%;复发部位共53个。单因素分析结果显示未/低分化鳞癌、pT3+4期、术后病理阳性淋巴结数≥3个和术后显示腹腔淋巴结阳性为影响腹腔淋巴结复发因素(P=0.032、0.001、0.009、0.000)。多元回归分析病理T分期、术后病理显示腹腔淋巴结阳性为影响腹腔淋巴结复发因素(P=0.011、0.000)。术后放疗可以提高术后腹腔淋巴结阳性和pT3+4期患者OS和LC,而对降低DMFS作用有限。结论 T分期和术后腹腔淋巴结阳性为胸中段食管鳞癌患者根治术后腹腔淋巴结复发的重要危险因素,建议对pT3+T4期期和术后病理显示腹腔淋巴结阳性患者进行术后辅助治疗。     

食管鳞癌术后局部区域复发患者接受不同照射方式获益人群的初步分析

目的 探讨胸段食管鳞癌患者术后局部区域复发接受放疗患者不同照射方式的人群获益情况。方法 回顾性分析2009-2014年间河北医科大学第四医院 344例食管癌术后复发接受了调强适形放疗或同步化放疗患者的病历资料,分析患者的复发部位分布的情况、预后影响因素,并对接受选择性淋巴结照射(ENI)和累及野照射(IFI)两种方式的获益人群进行分层分析。结果 术后单区域复发 276例(80.2%),其中≥2个区域复发 68例(19.8%)。随访率96.2%。全组患者1、3、5年总生存率分别为53.6%、22.6%、16.4%,中位生存期12.8个月(95%CI为 11.3~14.3个月);1、3、5年无局部复发生存率分别为46.5%、16.9%、12.0%,中位生存期11.0个月(95%CI为 9.6~12.4个月);1、3、5年无进展生存率分别为39.8%、11.3%、6.7%,中位生存期7.9个月(95%CI为 5.8~10.0个月)。全组多因素分析结果显示患者性别、阳性淋巴结对数比(LODDS)、化疗周期数均为患者预后的独立影响因素(P=0.003、<0.001、<0.001)。亚组单因素分析结果显示对食管病变长度<5.0cm、N0期、手术清扫淋巴结≤9个、术后阳性淋巴结转移区域数为0个、LODDS≤0.030患者进行ENI可使其受益(P=0.032、0.012、0.001、0.012、0.014);而对手术清扫淋巴结≥16个患者进行IFI可使其获益(P=0.035)。结论 放疗为食管癌术后局部区域复发患者的有效治疗模式,对于术前食管造影显示食管病变较短、术后病理N分期较早、LODDS评分较低和清扫淋巴结数目较少者可能应用ENI较IFI更能使其获益;而术中清扫淋巴结数目较多患者可能应用IFI较ENI更能使其获益。     

Number of negative lymph nodes should be considered for incorporation into staging for breast cancer

This study aimed to investigate the prognostic value of the number of involved lymph nodes (pN), number of removed lymph nodes (RLNs), lymph node ratio (LNR), number of negative lymph nodes (NLNs), and log odds of positive lymph nodes (LODDS) in breast cancer patients. The records of 2,515 breast cancer patients who received a mastectomy or breast-conserving surgery were retrospectively reviewed. The log-rank test was used to compare survival curves, and Cox regression analysis was performed to identify prognostic factors. The median follow-up time was 64.2 months, and the 8-year disease-free survival (DFS) and overall survival (OS) were 74.6% and 82.3%, respectively. Univariate analysis showed that pN stage, LNR, number of RLNs, and number of NLNs were significant prognostic factors for DFS and OS (all, P < 0.05). LODDS was a significant prognostic factor for OS (P = 0.021). Multivariate analysis indicated that pN stage and the number of NLNs were independent prognostic factors for DFS and OS. A higher number of NLNs was associated with higher DFS and OS, and a higher number of involved lymph nodes were associated with poorer DFS and OS. Patients with a NLNs count > 9 had better survival (P < 0.001). Subgroup analysis showed that the NLNs count had a prognostic value in patients with different pT stages and different lymph node status (log-rank P < 0.05). For breast cancer, pN stage and NLNs count have a better prognostic value compared to the RLNs count, LNR, and LODDS. Number of negative lymph nodes should be considered for incorporation into staging for breast cancer.     

三种淋巴结分期方法预测Ⅲ期直肠癌预后价值的比较

目的:评价以淋巴结转移数目、淋巴结转移率(LNR)和阳性淋巴结对数比(LODDS)为基础的pN分期、LNR分期和LODDS分期预测Ⅲ期直肠癌患者预后的价值。方法:回顾性分析徐州医科大学附属医院2011年至2015年249例接受直肠癌根治手术、病理确诊为Ⅲ期直肠癌患者的临床资料。采用Kaplan-Meier法和多因素Cox比例风险模型分析影响患者预后的独立危险因素，采用受试者工作特征(ROC)曲线比较pN、LNR和LODDS分期对患者5年生存预测的价值。结果:全组患者术后1、3、5年生存率分别为89.16％、73.90％和54.62％。Cox多因素分析显示LODDS分期是影响Ⅲ期直肠癌患者预后的独立危险因素(P<0.05)。pN分期、LNR分期和 LODDS分期预测患者预后所对应的ROC曲线下面积分别为0.683、0.769和0.778，但差异无统计学意义(P＞0.05)。结论:LODDS分期是影响Ⅲ期直肠癌患者预后的独立危险因素，LODDS分期对直肠癌患者预后的预测价值优于以pN分期为基础的TNM分期。     

Log odds of positive lymph nodes

BACKGROUND:

Log odds of positive lymph nodes (LODDS) is defined as the log of the ratio between the probability of being a positive lymph nodes and the probability of being a negative lymph nodes when one lymph node is retrieved. The value of LODDS staging system on prognostic assessment for gastric cancer patients with R0 resection is still unclear.

METHODS:

Clinicopathologic and prognostic data of 2547 gastric cancer patients underwent D2 or D3 lymphadenectomy with R0 surgery were retrospectively studied.

RESULTS:

Multivariate analysis indentified LODDS stage was an independent prognostic factor, but not pN classification or rN classification. The scatter plots of the relationship between LODDS and the number, the ratio of nodes metastasis, suggested that the LODDS stage had power to divide patients with the same number or ratio of nodes metastasis into different groups. For patients in each of the pN or rN classifications, significant differences in survival could always be observed among patients in different LODDS stages. However, for patients in each LODDS stage, prognosis was highly homologous between those in different pN or rN classifications. A minimum number of 10, 15, 20, 25, and 10 nodes retrieved should be met for patients in the pN0, pN1, pN2, pN3, and rN0‐3 classifications, respectively, unless the hazard risks of death would be underestimated or overestimated. However, LODDS stage could discriminate among 5 groups of patients with highly homologous prognosis, regardless how many nodes retrieved.

CONCLUSIONS:

The LODDS system is more reliable than the Union Internationale Contre le Cancer and American Joint Committee on cancer pN system and the rN system for prognostic assessment. Cancer 2010. © 2010 American Cancer Society.     

Prognosis of patients with esophageal squamous cell carcinoma after esophagectomy using the log odds of positive lymph nodes

To compare the log odds of positive lymph nodes (LODDS) with the number of positive lymph nodes (pN), lymph node ratio (LNR), removed lymph node (RLN) count, and negative lymph node (NLN) count in determining the prognosis of patients with esophageal squamous cell carcinoma (ESCC) after esophagectomy. The records of patients with ESCC who received esophagectomy were retrospectively reviewed. The log-rank test was used to compare curves for overall survival (OS), and Cox regression analysis was performed to identify prognostic factors. The prognostic performance of the different lymph node staging systems were compared using the linear trend chi-square test, likelihood ratio chi-square test, and Akaike information criterion. A total of 589 patients were enrolled. Univariate Cox analysis showed that pN stage, LNR, RLN count, NLN count, and the LODDS were significantly associated with OS (p < 0.05 for all). Multivariate Cox analysis adjusted for significant factors indicated that LODDS was independent risk factor on overall survival (OS), and a higher LODDS was associated with worse OS (hazard ratio = 3.297, 95% confidence interval: 2.684–4.050, p < 0.001). The modified Tumor-LODDS-Metastasis staging system had better discriminatory ability, monotonicity, and homogeneity, and better optimistic prognostic stratification than the Tumor-Node-Metastasis staging system in determining the prognosis of patients with ESCC. The LODDS staging system was superior to other lymph node classifications in determining the prognosis of patients with ESCC after esophagectomy. LODDS may be incorporated into esophageal staging system if these results are eventually confirmed by other studies.     

Comprehensive analysis of prognostic value of lymph node staging classifications in patients with head and neck squamous cell carcinoma after cervical lymph node dissection

PurposeTo determine the optimal threshold of examined lymph node (ELN) number from cervical lymph node dissection for head and neck squamous cell carcinoma (HNSCC). Further to compare the prognostic value of multiple lymph node classification systems and to determine the most suitable scheme to predict survival.MethodsA total of 20991 HNSCC patients were included. Odds ratios (ORs) for negative-to-positive node stage migration and hazard ratios (HRs) for survival were fitted using the LOWESS smoother. Structural breakpoints were determined by the Chow test. The R square, C-index, likelihood ratio, and Akaike information criterion (AIC) were used to compare the prognostic abilities among AJCC N stage, number of positive lymph nodes (pN), positive lymph node ratio (LNR) and log odds of positive lymph nodes (LODDS) stages.ResultsA minimal threshold ELN number of fifteen had the discriminatory capacities for both stage migration and survival. LODDS stages had the highest R square value (0.208), C-index (0.736) and likelihood ratio (2467) and the smallest AIC value (65874). LODDS stages also showed prognostic value in estimating patients with AJCC N0 stage. A novel staging system was proposed and showed good prognostic performance when stratified by different primary sites.ConclusionFifteen lymph nodes should be examined for HNSCC patients. LODDS stage allows better prognostic stratification, especially in N0 stage. The proposed staging system may serve as precise evaluation tools to estimate postoperative prognoses.     

Lymph Node Ratio and pN Staging Show Different Superiority As Prognostic Predictors Depending on the Number of Lymph Nodes Dissected in Chinese Patients With Luminal A Breast Cancer

BackgroundThe lymph node ratio (LNR) classification has shown superiority to pN staging (the number of positive lymph nodes) in breast cancers, but it has not been examined according to whether sufficient lymph nodes have been dissected.MethodsAll Chinese patients with luminal A breast cancer with positive lymph nodes seen at Sun Yat-sen University Cancer Center between 1995 and 2009 were enrolled. Disease-free survival (DFS) and overall survival (OS) were the endpoints, and the patients were further classified into 2 groups according to whether ≤ 10 or > 10 lymph nodes were dissected.ResultsFor the whole group, the OS curves of the pN stages overlapped, whereas they were separated in the LNR survival curves. LNR was an independent prognostic factor for OS and DFS, whereas the pN stage was not. In the ≤ 10 lymph nodes dissected group, both OS and DFS curves were clearly separated in the pN staging but overlapped in the LNR classification. In the > 10 lymph nodes dissected group, LNR showed no overlap in the OS curves and was an independent prognostic factor of OS and DFS when compared with pN staging.ConclusionIn Chinese patients with luminal A breast cancer, LNR classification and the pN stage show different superiority as prognostic predictors according to whether > 10 or < 10 lymph nodes are dissected.     

pT3N0M0期胸段食管鳞癌患者术后失败原因分析及其术后放疗思考

目的 探讨pT₃N₀M₀期胸段食管鳞癌患者术后失败模式,并依据其失败模式讨论术后放疗意义及可行性。方法 对2007-2010年符合入组条件的227例pT₃N₀M₀期食管癌术后患者进行回顾分析,主要分析其单纯手术后失败模式,同时结合相关研究来探讨pT₃N₀M₀期胸段食管鳞癌患者术后辅助性放疗意义及适合人群。应用Kaplan-Meier法计算OS、LR、DM并Logrank法检验和单因素预后分析,Cox模型多因素预后分析。结果 治疗后出现胸腔内LR 58例(25.6%),DM 27例(11.9%),其中10例为LR+DM。单纯胸腔内纵隔淋巴结复发所占比率为50%(29/58)。单因素分析显示胸上段食管癌患者术后3、5年OS率低于胸中、下段患者(P=0.000),而其胸腔-区域复发率高于后两者(P=0.047);低分化鳞癌患者3、5年OS率低于中高分化鳞癌患者(P=0.005),而其DM率高于后者(P=0.000)。多因素分析显示患者不同病变部位、不同病理分化程度为患者OS的影响因素(P=0.014、0.010);病变部位为影响患者胸腔内LR的影响因素(P=0.046);不同病理分化程度为DM的影响因素(P=0.000)。结论 pT₃N₀M₀期胸段食管鳞癌患者行常规胸腹两野根治术后胸腔内LR为其主要治疗失败模式,且胸上段食管癌高于胸中、下段食管癌患者,建议pT₃N₀M₀期胸段食管鳞癌胸上段患者行术后放疗。     

Bcl-2、miR-451和Th17细胞在食管癌中的诊断价值及其与复发的关系

目的 探讨Bcl-2、miR-451、Th17细胞在食管癌中的诊断价值及其与复发的关系。方法 选取101例食管癌患者作为研究组,95例健康体检者作为对照组。分析两组临床病理特征与各外周血指标水平之间的相关性,ROC曲线分析各外周血指标诊断价值,多元线性回归分析各指标与肿瘤复发的关系。结果 研究组外周血Bcl-2、miR-451和Th17细胞水平均高于对照组（均P<0.05）;分化程度、临床分期、肿瘤直径、淋巴结转移与外周血Bcl-2、miR-451和Th17细胞水平呈正相关（均P<0.05）。复发患者外周血Bcl-2、miR-451和Th17细胞水平均高于未复发患者（均P<0.05）;控制分化程度、临床分期、肿瘤大小、淋巴结转移等其他因素后,外周血Bcl-2、miR-451和Th17细胞水平与复发显著相关（均P<0.05）。结论 食管癌患者外周血Bcl-2、miR-451和Th17细胞异常表达且表达水平与分化程度、临床分期及复发等密切相关,联合检测可为临床诊断、预后评估提供客观依据。