T1期食管鳞癌淋巴结转移及预后危险因素分析

目的探讨T1期食管鳞癌淋巴结转移及预后的危险因素。方法收集2013年3月至2018年3月在上海长海医院胸外科行外科手术治疗的387例T1期食管鳞癌患者的临床资料,其中男281例、女106例,中位年龄60(41,80)岁。将患者分为淋巴结转移组(n=77)和非转移组(n=310),分析淋巴结转移和预后的危险因素。结果387例T1期食管癌患者中,77例(19.9%)发生淋巴结转移,T1a期淋巴结转移率为8.4%(8/95),T1b期淋巴结转移率为23.6%(69/292)。单因素分析显示肿瘤长度、分化程度、浸润深度和脉管有无癌栓与淋巴结转移有关(P<0.05)。多因素logistic回归分析结果显示肿瘤浸润深度OR=2.456,95%CI(1.104,5.463),P<0.05]、脉管癌栓OR=15.766,95%CI(4.880,50.938),P<0.05]是T1期食管癌淋巴结转移的独立危险因素。中位随访时间41(12,66)个月,失访20例(5.2%),死亡51例。T1期食管癌患者1年、3年、5年生存率分别为98.71%、89.67%、86.82%。单因素分析显示死亡组与非死亡组之间肿瘤浸润深度、脉管癌栓、淋巴结转移差异有统计学意义(P<0.05)。Cox回归分析显示淋巴结转移OR=3.794,95%CI(2.109,6.824),P<0.05]为预后的独立危险因素。结论T1期食管鳞癌浸润至黏膜下层或存在脉管癌栓者淋巴结转移的风险较高。伴有淋巴结转移的T1期食管鳞癌预后相对较差。

Analysis of risk factors for lymph node metastasis and prognosis in T1-stage esophageal squamous cell carcinoma

Objective To investigate the risk factors for lymph node metastasis(LNM)and prognosis of T1-stage esophageal squamous carcinoma(ESC).Methods Clinical data of 387 patients with T1-stage ESC who underwent surgical treatment in our hospital from March 2013 to March 2018 were collected.There were 281 males and 106 females aged 60(41-80)years.The patients were divided into a lymph node metastasis group(n=77)and a non-metastasis group(n=310).The risk factors for LNM and prognosis were analyzed.Results Among 387 patients with T1-stage ESC,77(19.9%)patients had LNM.The incidence of LNM was 8.4%(8/95)in T1 a-stage patients and 23.6%(69/292)in T1 b-stage patients.Univariate analysis showed that tumor size,differentiation degree,depth of invasion and vascular tumor thrombus were associated with LNM(P<0.05).Multivariate logistic regression analysis showed that invasion depth of tumorOR=2.456,95%CI(1.104,5.463),P<0.05]and vascular tumor thrombusOR=15.766,95%CI(4.880,50.938),P<0.05]were independent risk factors for LNM.The follow-up time was 41(12,66)months.The 1-year,3-year and 5-year survival rates were 98.71%,89.67%and 86.82%,respectively.Univariate analysis showed statistically significant differences in tumor invasion depth,vascular tumor thrombus and LNM between the survival group and the death group.Cox analysis showed that LNMOR=3.794,95%CI(2.109,6.824),P<0.05]was an independent risk factor for prognosis.Conclusion T1-stage ESC patients with deeper invasion or vascular tumor thrombus have a higher risk of LNM.The prognosis of T1-stage ESC with LNM is relatively poor.