食管癌术后淋巴结跳跃性转移的影响因素及与预后的关系

目的:探讨跳跃性淋巴结转移（nodal skip metastasis,NSM）预测食管癌术后淋巴结阳性患者的预后价值及其出现的影响因素。方法:回顾性分析362例食管癌术后淋巴结阳性患者的临床病理数据，将患者分为NSM组和非淋巴结跳跃性转移（NNSM）组。利用SPSS 25.0统计软件统计分析两组患者预后的差异、影响NSM出现的独立性危险因素、全组患者独立性预后影响因素及两组患者治疗后失败情况等，并应用倾向性评分匹配（PSM）分析减少一些偏差和混杂变量。结果:患者中位OS时间和PFS时间分别为26.0个月（95%CI:23.1~28.9）和18.0个月（95%CI:14.8~21.2）。NSM组与NNSM组患者中位OS时间分别为33.0个月和24.0个月（χ2=8.025，P=0.005）；中位PFS时间分别为24.1个月和14.3个月（χ2=5.012，P=0.025）。Logistics多因素分析结果显示食管癌病变部位和病理N分期为影响患者出现NSM的独立性危险因素（P=0.000、0.000）。PSM后NSM组患者的1、3、5年OS和PFS也均显著性优于NNSM组患者（χ2=5.301、4.581，P=0.021,0.032）。COX多因素分析结果显示患者性别、年龄、食管癌病变部位、病理N分期和淋巴结转移状态均为影响患者OS和PFS的独立性危险因素（P=0.024、0.004、0.000、0.016、0.001和0.009、0.008、0.000、0.010、0.006）。结论:NSM为食管癌术后淋巴结阳性患者预后较好的预测指标，且病变部位和病理N分期为影响NSM出现的独立性危险因素；NSM与NNSM组患者治疗后失败情况无显著性差异。最终的研究结论需要进一步开展多中心、前瞻性大宗病例的随机对照相关研究得出。

Influencing factors of lymph node skip metastasis after esophageal cancer surgery and its relationship with prognosis

Objective:To investigate the prognostic value of skip lymph node metastasis (NSM) in patients with positive lymph nodes after esophageal cancer surgery and its influencing factors.Methods:The clinicopathological data of 362 patients with positive lymph nodes after esophageal cancer surgery were retrospectively analyzed.The patients were divided into NSM group and non-lymph node skipping metastasis (NNSM) group.Using SPSS 25.0 statistical software to statistically analyze the differences in the prognosis of the two groups of patients,the independent risk factors that affect the appearance of NSM,the independent prognostic factors of the entire group of patients,and the failure mode of the two groups of patients.The bias and confounding variables were reduced by PSM analysis.Results:The median OS time and PFS time of the entire group of patients were 26.0 months (95%CI:23.1~28.9) and 18.0 months (95%CI:14.8~21.2),respectively.The median OS time of patients in the NSM group and NNSM group were 33.0 months and 24.0 months,respectively (χ2=8.025,P=0.005).The median PFS time were 24.1 months and 14.3 months,respectively (χ2=5.012,P=0.025).The results of Logistics multivariate analysis showed that the lesion location and pathological N stage of esophageal cancer were independent risk factors that affected the appearance of NSM in patients (P=0.000,0.000).The 1,3 and 5 years OS and PFS of NSM after PSM were also significantly better than those of NNSM group (χ2=5.301,4.581;P=0.021,0.032).COX multivariate analysis showed that the patient's gender,age,esophageal cancer lesion location,pathological N stage,and lymph node metastasis status were all independent risk factors affecting the patient's OS and PFS (P=0.024,0.004,0.000,0.016,0.001 and 0.009,0.008,0.000,0.010,0.006).Conclusion:NSM is a good predictor of prognosis for patients with positive lymph nodes after esophageal cancer surgery,and the lesion location and pathological N stage are independent risk factors that affect the appearance of NSM.There was no significant difference in failure mode between NSM and NNSM groups.The final research conclusions need to be further carried out multi-center,prospective randomized controlled studies of large cases.