摘要
目的：探讨食管鳞癌患者肿瘤最大长径（maximum tumor length，MTL）与淋巴结转移的关系，为术前判断淋巴结转移提供依据。方法40822例食管鳞癌患者均来自河南省食管癌重点开放实验室50万例食管及贲门癌临床信息库（1973－2015年），其中男性26225例，平均年龄（60±9）岁；女性14597例，平均年龄（60±9）岁。40822例食管鳞癌患者 MTL 和淋巴结转移情况均来自术后医院病理结果报告，依 MTL 将患者分为5组（＜2 cm，2～4 cm，4～6 cm，6～8 cm和≥8 cm）。采用 Spearman 秩相关和 Logistic 回归分析 MTL 和淋巴结转移的关系。结果40822例食管鳞癌患者平均MTL 为（4．4±1．8）cm，中位数为4 cm（0．3～16．0 cm）。肿瘤长度依次从＜2 cm 至≥8 cm 的5组患者比例分别为1489（3．6％）、13029（31．9％）、16924（41．5％）、7365（18．0％）及2015（4．9％）。Spearman 秩相关显示随 MTL 增长，食管鳞癌患者淋巴结转移阳性率（N1）明显升高（r ＝0．998，P ＝0．000）。调整因素后的 Logistic 回归分析结果显示，食管鳞癌MTL 是淋巴结转移的重要影响因素（OR ＝1．329，95％ CI ＝1．292～1．366，P ＝0．000），且随着 MTL 增长，淋巴结转移风险增高（MTL ＝2～4 cm，OR ＝1．393，95％ CI ＝1．177～1．649，P ＝0．000；MTL ＝4～6 cm，OR ＝1．944，95％ CI ＝1．644～2．299，P ＝0．000；MTL ＝6～8 cm，OR ＝2．526，95％ CI ＝2．215～3．003，P ＝0．000；MTL≥8 cm，OR ＝3．045，95％ CI ＝2.507～3．699，P ＝0．000）。结论食管鳞癌 MTL 与淋巴结转移密切相关，随 MTL 增长淋巴结转移阳性率明显升高，提示肿瘤长度可作为临床术前评判淋巴结是否转移的重要参考指标。
Abstract
Objective To characterize the relationship between maximum tumor length (MTL)and lymph node metastasis (LNM) in esophageal squamous cell carcinoma (ESCC),providing an evi-dence for preoperative judgment of LNM.Methods All the 40 822 cases were from the clinical information databases of 500 000 esophageal and gastric cardiac carcinomas (1973 -2015) by the Henan Key Laboratory for Esophageal Cancer Research.Of the patients,there were 26 225 males with an average age of (60 ±9)years and 14 597 females with average age of (60 ±9)years.The MTL and LNMof 40 822 patients with ESCC were derived from postoperative pathology reports in hospitals.Based on MTL,the patients was classified into five groups (<2 cm, 2 ~4 cm,4 ~6 cm,6 ~8 cm and ≥8 cm).The difference between groups was analyzed by χ2 test;The relationship between MTL and LNM was analyzed by Spearman rank correlation and Logistic regression analysis.Results The average MTL was (4.4 ±1.8)cm,and the median MTL was 4 cm with a range of 0.3 ~16.0 cm.The number and rate of different MTL from <2 cm to ≥8 cm in 40 822 patients with ESCC were 1 489 (3.6%),13 029 (31.9%),16 924 (41.5%),7 365 (18.0%)and 2 015 (4.9%),respectively.Spearman rank correlation analysis indicated an apparent positive correlation be-tween MTL and LNM(r =0.998,P =0.000).Adjusted Logistic regression showed that MTL was an important influence factor of LNM(OR =1.329,95% CI =1.292 ~1.366,P =0.000),and MTL increased the risk of LNM (MTL =2 ~4 cm,OR =1.393,95% CI =1.177 ~1.649,P =0.000;MTL =4 ~6 cm,OR =1.944,95% CI =1.644 ~2.299,P =0.000;MTL =6 ~8 cm,OR =2.526,95% CI =2.215 ~3.003,P =0.000;MTL≥8 cm,OR =3.045,95% CI =2.507 ~3.699,P =0.000).Conclusion The MTL was closely related to lymph node metastasis in ESCC.The MTL could be used as an important clinical reference index for the evaluation of LNMstatus before operation.
基金项目
国家自然科学基金委员会()
广东省联合重大项目资助(U1301227)
国家科技部863重点专项资助(SQ2015AA0202183)
NETL
NSTL
维普
万方数据