淋巴结清扫总数对胸段食管鳞状细胞癌患者预后的影响  

Effect of total number of lymph node dissected on prognosis in patients with thoracic esophageal squamous cell carcinoma

作　　者：李畅波[1] 莫俊贤 LI Chang-bo;MO Jun-xian(Department of Cardio-Thoracic Surgery,the Seventh Affiliated Hospital of Guangxi Medical University&Wuzhou Gongren Hospital,Wuzhou 543000,China)

机构地区：[1]广西医科大学附属第七医院/梧州市工人医院心胸外科,梧州市543000

出　　处：《广西医学》2021年第7期819-823,828,共6页Guangxi Medical Journal

摘　　要：目的探讨淋巴结清扫总数对胸段食管鳞状细胞癌患者预后的影响。方法回顾性分析行食管癌根治术治疗的121例胸段食管鳞癌患者的临床资料。采用受试者工作特征(ROC)曲线及约登指数最大法确定淋巴结清扫总数的最佳截断点,采用Kaplan-Meier法绘制生存曲线,采用Cox回归模型分析相关临床病理因素与患者预后的关系。结果ROC曲线法及约登指数最大法确定淋巴结清扫总数最佳截断点为15枚(曲线下面积为0.667,P<0.001)。相对于淋巴结清扫总数<15枚的患者,淋巴结清扫总数≥15枚的胸段食管鳞癌患者的预后更好(P<0.05)。多因素Cox回归分析结果显示,淋巴结清扫总数≥15枚和术后辅助治疗是影响患者预后的保护因素,而淋巴结高分期及术后复发和转移是影响患者预后的危险因素(均P<0.05)。结论淋巴结清扫总数、术后辅助治疗、淋巴结分期、术后复发或转移均为影响胸段食管鳞癌患者预后的独立因素,其中淋巴结清扫总数≥15枚为胸段食管鳞癌患者预后的保护因素。Objective To investigate the effect of total number of lymph node dissected on the prognosis in patients with thoracic esophageal squamous cell carcinoma.Methods The clinical data of 121 patients with thoracic esophageal squamous cell carcinoma who underwent radical esophagectomy were retrospectively analyzed.Receiver operating characteristic(ROC)curve and maximum Youden index were used to confirm the optimal cut-off point of total number of lymph node dissected.The Kaplan-Meier method was used to draw the survival curve,and the Cox regression model was employed to analyze the relationship between relevant clinicopathological factors and prognosis in the patients.Results The optimal cut-off point of total number of lymph node dissected was 15 identified by ROC curve and maximum Youden index(the area under the curve was 0.667,P<0.001).Compared with patients with less than 15 lymph nodes dissected,patients who suffered from thoracic esophageal squamous cell carcinoma and had no less than 15 lymph nodes dissected yielded better prognosis(P<0.05).The results of multivariate Cox regression analysis showed that total number of lymph node dissected no less than 15 and postoperative adjuvant treatment were the protective factors affecting patients′prognosis,while higher lymph node stage and postoperative recurrence and metastasis were the risk factors affecting patients′prognosis(all P<0.05).Conclusion Total number of lymph node dissected,postoperative adjuvant therapy,lymph node stage,postoperative recurrence or metastasis are the independent factors affecting the prognosis of patients with thoracic esophageal squamous cell carcinoma,and total number of lymph node dissected no less than 15 is the protective factor for the prognosis of patients with thoracic esophageal squamous cell carcinoma.

关 键 词：食管鳞状细胞癌 胸段 淋巴结清扫总数 预后 临床病理特征 影响因素 

分 类 号：R735.1[医药卫生—肿瘤]