食管鳞状细胞癌患者主诉与病理分期的关系  

Relationship between chief complaints of patients with esophageal squamous cell carcinoma and the pathological stage

作　　者：宋昕[1] 李欣然 胡景峰 王伟[1] 周福有[2] 刘志才[3] 李爱丽[3] 李吉林 王献增 李学民 王盼盼[1] 钟侃 王苒[1] 范宗民[1] 韩文莉 吉佳佳 雷玲玲 王立东[1] SONG Xin;LI Xinran;HU Jingfeng;WANG Wei;ZHOU Fuyou;LIU Zhicai;LI Aili;LI Jilin;WANG Xianzeng;LI Xuemin;WANG Panpan;ZHONG Kan;WANG Ran;FAN Zongmin;HAN Wenli;JI Jiajia;LEI Lingling;WANG Lidong(State Key Laboratory of Esophageal Cancer Prevention and Treatment,the First Affiliated Hospital,Zhengzhou University,Zhengzhou 450052;Department of Thoracic Surgery,Anyang Tumor Hospital,Anyang,Henan 455000;Department of Oncology,Linzhou Tumor Hospital,Linzhou,Henan 456550;Department of Pathology,Linzhou Esophageal Cancer Hospital,Linzhou,Henan 456592;Department of Oncology,Linzhou People′s Hospital,Linzhou,Henan 456550;Department of Pathology,Cixian People′s Hospital,Handan,Hebei 056599)

机构地区：[1]郑州大学第一附属医院省部共建食管癌防治国家重点实验室,郑州450052 [2]安阳市肿瘤医院胸外科,河南安阳455000 [3]林州市肿瘤医院肿瘤科,河南林州456550 [4]林州市食管癌医院病理科,河南林州456592 [5]林州市人民医院肿瘤科,河南林州456550 [6]磁县人民医院病理科,河北邯郸056599

出　　处：《郑州大学学报（医学版）》2022年第2期161-164,共4页Journal of Zhengzhou University(Medical Sciences)

基　　金：国家自然科学基金面上项目(81872032)。

摘　　要：目的:探讨食管鳞状细胞癌(食管鳞癌)患者主诉与病理分期的关系。方法:85919例食管鳞癌病例均来自郑州大学第一附属医院省部共建食管癌防治国家重点实验室建立的50万例食管/贲门癌患者临床信息数据库,根据AJCC食管癌肿瘤淋巴结转移分期系统(第6版)进行病理分期,其中早期(0/Ⅰ期)8129例,中晚期(Ⅱ/Ⅲ/Ⅳ期)77790例。数量较少(<100例)的主诉不纳入研究。比较早中晚期患者首次就诊各类主诉的频率。将85919例随机分为10组,随机选取其中9组作为训练集,采用Logistic回归分析建立主诉对早中晚分期的预测模型;剩余1组作为测试集,通过绘制ROC曲线,对模型预测效能进行评价。结果:早期和中晚期患者吞咽哽噎、吞咽疼痛、腹部不适、胸骨疼痛、腹部疼痛、胸骨后不适、吞咽哽噎伴胸部疼痛、胸部疼痛、反酸和呃逆这10种主诉频率差异有统计学意义(P<0.001)。以病理分期(早期为1,中晚期为0)为因变量,以上述差异主诉作为自变量(有=1,无=0),以性别、年龄、高低发区等特征作为调整因素,采用逐步法进行Logistic回归,结果吞咽哽噎(β=-1.906,P<0.001)、吞咽疼痛(β=-0.662,P<0.001)、胸骨疼痛(β=-0.219,P=0.005)、腹部疼痛(β=-0.392,P<0.001)、吞咽哽噎伴胸部疼痛(β=-2.069,P<0.001)、胸部疼痛(β=-0.742,P<0.001)、反酸(β=-0.562,P=0.001)和呃逆(β=-0.842,P<0.001)进入最终模型。该模型预测的ROC曲线下面积(95%CI)0.694(0.560~0.829)。结论:多种主诉联合对食管鳞癌早中晚分期具有一定的预测价值。Aim:To explore the relationship between chief complaints of patients with esophageal squamous cell carcinoma(ESCC)and the pathological stage.Methods:A total of 85919 cases of ESCC were collected from the clinical information database of 500 thousands cases of esophageal/cardiac carcinoma established by the State Key Laboratory of Esophageal Cancer Prevention and Treatment of the First Affiliated Hospital of Zhengzhou University.Pathological staging was performed according to the 6th edition of AJCC tumor lymph node metastasis staging system,and 8129 cases were early stage(stage 0/Ⅰ),77790 were middle-late stage(Ⅱ/Ⅲ/Ⅳ).The chief complaint presented by less than 100 cases were excluded.The frequency of primary chief complaints of early and middle-late stage patients was compared.The 85919 cases were randomly allocated into 10 groups,9 of which were randomly selected as training sets.The prediction model of chief complaints for the stages was established by Logistic regression analysis.The remaining 1 group was the test set,and the ROC curve was drawn to evaluate the prediction efficiency of the model.Results:There were significant differences in frequency of dysphagia,pain on swallowing,abdominal discomfort,sternal pain,abdominal pain,retrosternal discomfort,dysphagia with chest pain,chest pain,acid reflux and hiccup between early and middle-late stage patients(P<0.001).The pathological stage(early stage=1,middle-late stage=0)was taken as the dependent variable,the complaints mentioned above were taken as the independent variable(yes=1,no=0),gender,age,high/low incidence area were taken as the adjustment factors,and the stepwise Logistic regression method was used.The model included dysphagia(β=-1.906,P<0.001),pain on swallowing(β=-0.662,P<0.001),sternal pain(β=-0.219,P=0.005),abdominal pain(β=-0.392,P<0.001),dysphagia with chest pain(β=-2.069,P<0.001),chest pain(β=-0.742,P<0.001),acid reflux(β=-0.562,P=0.001)and hiccup(β=-0.842,P<0.001).In the test set,the area under the ROC curve(95%CI)of the mode

关 键 词：食管鳞状细胞癌 主诉 病理分期 

分 类 号：R735.1[医药卫生—肿瘤]