食管鳞癌肿瘤最大长径与浸润深度(T分期)的关系  

Relationship between the maximum tumor length and invasion depth (T Stage) in esophageal squamous cell carcinoma

作　　者：吕双[1,2] 宋昕[1] 赵学科[1] 陈培楠[1] 范宗民[1] 胡守佳[1] 程让[1] 杜丹凤[1] 张向阳[1] 鲁建亮 王苒[1] 周福有[3] 王立东[1] 

机构地区：[1]郑州大学第一附属医院河南省食管癌重点开放实验室,郑州450052 [2]新乡医学院基础医学院病理学教研室,河南新乡453003 [3]安阳肿瘤医院胸外科,河南安阳455000

出　　处：《郑州大学学报（医学版）》2017年第5期522-526,共5页Journal of Zhengzhou University(Medical Sciences)

基　　金：国家自然科学基金委员会和广东省联合重大项目资助U1301227;河南省科技重大专项资助161100311300

摘　　要：目的:探讨食管鳞癌患者肿瘤最大长径(MTL)与浸润深度(T分期)的关系,为准确判断临床T分期及临床治疗方式选择提供依据。方法:21 712例食管鳞癌患者中男性13 009例,女性8 703例。通过对根治术后食管大标本形态测量和镜下观察,记录每例患者MTL和肿瘤浸润程度(T分期)。分析食管鳞癌患者一般临床特征及MTL与T分期的关系,运用SPPS软件的决策树模型决定截点值,采用Spearman秩相关和logistic回归分析MTL和T分期的关系。结果:21 712例食管鳞癌患者MTL为0.2~16.5(4.1±1.7)cm。Spearman秩相关显示MTL与T分期呈正相关(rS=0.355,P<0.001)。取3.9 cm为MTL的截点值,logistic回归分析显示,MTL>3.9 cm的患者,T2+T3期的发生风险比≤3.9 cm组明显上升7.146倍(95%CI=6.449~7.918,P<0.001)。男性患者MTL高于女性患者[(4.2±1.8)cm vs(3.9±1.6)cm,P<0.001]。Spearman秩相关分析显示男性和女性患者MTL均与T分期呈正相关(男:rS=0.341,P<0.001;女:rS=0.369,P<0.001)。Logistic回归分析显示:MTL>3.9 cm时,男性和女性T2+T3期的风险均明显升高(男:7.251倍,95%CI=6.343~8.288,P<0.001;女:7.315倍,95%CI=6.234~8.584,P<0.001)。结论:食管鳞癌MTL与T分期呈正相关,MTL>3.9 cm是灵敏反映T分期严重程度的截点值。Aim： To characterize the relationship between the maximum tumor length（ MTL） and invasion depth（ T stage） of esophageal squamous cell carcinoma（ ESCC） for clinical T stage classification and precision treatment. Methods：A total of 21 712 cases of ESCC consisted of 13 009 males and 8 703 females. MTL and depth of infiltration（ T stage） for each patient were recorded based on surgical specimen measurement and light microscopy observation. The decision tree model based on SPSS software was applied to determine the cut-off point of MTL. Spearman rank correlation and logistic regression were used to analyze the relationship between MTL and T stage. Results： The average MTL for 21 712 ESCC patients was 0. 2-16. 5（ 4. 1 ± 1. 7） cm. Spearman rank correlation analysis indicated a positive correlation between MTL and T stage（ rS= 0. 355,P〈0. 001）. Logistic regression analysis showed that the risk of T2 and T3 increased 7. 146 times in the patients with a cut-off value of MTL 3. 9 cm（ 95% CI = 6. 449-7. 918,P〈0. 001）. The average MTL in male patients was higher than that in females[（ 4. 2 ± 1. 8） cm vs（ 3. 9 ± 1. 6） cm,P〈0. 001]. An apparent positive correlation of MTL and T stage was observed both in males（ rS= 0. 341,P〈0. 001） and females（ rS= 0. 369,P〈0. 001）. Logistic regression analysis indicated that the risk of T2 and T3 increased at the cut-off value of MTL 3. 9 cm both in males and females（ male： 7. 251 times,95% CI = 6. 343-8. 288,P〈0. 001; female： 7. 315 times,95% CI = 6. 234-8. 584,P〈0. 001）. Conclusion： The present study demonstrates a positive correlation between MTL and T stage in ESCC. MTL 3. 9 cm is a sensitive cut-off point to reflect the severity of T stage.

关 键 词：食管鳞癌 肿瘤最大长径 浸润深度 T分期 

分 类 号：R735.1[医药卫生—肿瘤]