胸段食管鳞癌隆突下淋巴结转移的风险分层  

Risk Stratification of Subcarinal Lymph Node Metastasis in Patients with Thoracic Esophageal Squamous Cell Carcinoma

作　　者：李强明 张国庆 侯志超[1] 刘旭东 刘天阳 赵松[1] 李向楠[1] LI Qiang-ming;ZHANG Guo-qing;HOU Zhi-chao;LIU Xu-dong;LIU Tian-yang;ZHAO Song;LI Xiang-nan(Department of Thoracic Surgery,the First Affiliated Hospital of Zhengzhou University,Zhengzhou 450052,China)

机构地区：[1]郑州大学第一附属医院胸外科,河南郑州450052

出　　处：《食管疾病》2020年第3期214-218,共5页Journal of Esophageal Diseases

基　　金：河南省科技厅科技攻关项目(172102310047);郑州大学2020年学科建设重点专项(前沿交叉专项XKZDQY202006)。

摘　　要：目的探讨胸段食管鳞癌隆突下淋巴结转移的危险因素,并建立隆突下淋巴结转移的预测模型及转移概率的风险分层。方法回顾性分析郑州大学第一附属医院胸外科2015年3月至2019年4月625例胸段食管鳞癌患者的临床病理资料。采用单因素和多因素分析胸段食管鳞癌隆突下淋巴结转移的危险因素,并基于独立危险因素采用Rstudio软件包建立隆突下淋巴结转移的nomogram模型。然后根据nomogram模型对隆突下淋巴结转移预测的总分进行"递归分割分析(RPA)",将患者进行风险分层。结果625例患者中有73例出现隆突下淋巴结转移,转移率为11.68%。单因素分析显示,肿瘤位置、肿瘤长度、肿瘤分化程度、病理T分期、神经侵犯、脉管侵犯和胸部淋巴结阳性(不计入隆突下淋巴结,下同)是胸段食管鳞癌隆突下淋巴结转移的危险因素,差异有统计学意义(均P<0.05);多因素Logistic回归分析显示,肿瘤长度、病理T分期和胸部淋巴结阳性是胸段食管鳞癌隆突下淋巴结转移的独立危险因素(均P<0.05)。基于肿瘤长度、病理T分期和胸部淋巴结转移数目建立了隆突下淋巴结转移的nomogram模型,模型c-指数为0.814。进一步,RPA依据隆突下淋巴结转移概率的高低将患者分为4个风险亚组。低危组:胸部阳性淋巴结总数0~2枚;中低危组:胸部阳性淋巴结总数3~4枚+肿瘤长度<5 cm;中高危组:胸部阳性淋巴结总数3~4枚+肿瘤长度≥5 cm;高危组:胸部阳性淋巴结总数≥5枚。各风险亚组隆突下淋巴结转移概率分别为8.22%、34.78%、53.85%和64.71%。结论肿瘤长度、病理T分期和胸部淋巴结阳性是胸段食管鳞癌隆突下淋巴结转移的独立危险因素。本研究建立的胸段食管鳞癌隆突下淋巴结转移的预测模型和风险分层,可以为胸外科医师行隆突下淋巴结清扫提供理论依据。Objective To investigate the risk factors of subcarinal lymph nodes(LN) metastasis in patients with thoracic esophageal squamous cell carcinoma(TE-SCC), and to perform a prediction model to stratify the probability of subcarinal LN metastasis. Methods 625 patients with TE-SCC, who received esophagectomy with subcarinal LNs dissection at the department of thoracic surgery of the First Affiliated Hospital of Zhengzhou University from March 2015 to April 2019, were retrospected. The risk factors of subcarinal LNs metastasis were analyzed by univariable and multivariable methods;based on independent risk factors, nomogram modelof subcarinal LN metastasis was established with R Studio software package;and, the total scores of subcarinal LN metastasis were predicted with RPA, and the risk was stratified. Results In the 625 patients, 73 patients were found with subcarinal LNs metastasis(11.68%). Single factor analysis showed that tumor location,tumor bed length,the degree of tumor differentiation, pathologic T classification,nerve invasion,vessel invasion,and positive thoracic LNs were the risk factors for metastasis of subcarinal LNs( P < 0. 05,respectively). Multivariable analysis showed that tumor bed length,pathologic T classification,and positive thoracic LNs were significantly associated with metastasis of subcarinal LNs( P<0.05,respectively).The concordance index( c-index) of the nomogram model was 0. 814. Finally,four risk subgroups were stratified with recursive partitioning analysis( RPA). The low-riskgroup,the intermediate low-riskgroup,the intermediate high-riskgroup,and the high-risk group have the risk of subcarinal LN metastasis 8. 22%,34. 78%,53. 85% and 64. 71%, respectively. Conclusion The tumor bed length, pathologic T classification,and positive thoracic LNs were independent risk factors for subcarinal LN metastasis of TESCC. These nomogram model and RPA stratification system could provide theoretical basis for clinicians to conduct subcarinal LNs dissection for TE-SCC.

关 键 词：食管癌 隆突下淋巴结转移 危险因素 递归分割 

分 类 号：R735.1[医药卫生—肿瘤]