T1期和T2期食管鳞癌根治术后淋巴结转移和预后影响因素分析及列线图预测模型构建  

Influencing factors for lymph node metastasis and prognosis in stage T1 and T2 esophageal squa-mous cell carcinoma after radical surgery and construction of nomogram prediction models

作　　者：郭珂璇 姜凯元 张静秋[1] 张丹 李红云 申春梅[1] 文红英[1] 田东[1] Guo Kexuan;Jiang Kaiyuan;Zhang Jingqiu;Zhang Dan;Li Hongyun;Shen Chunmei;Wen Hongying;Tian Dong(Department of Cardiothoracic Surgery,Affiliated Hospital of North Sichuan Medical College,Nanchong 637002,Sichuan Province,China)

机构地区：[1]川北医学院附属医院胸心外科,南充637002

出　　处：《中华消化外科杂志》2022年第10期1354-1362,共9页Chinese Journal of Digestive Surgery

基　　金：川北医学院自然科学基金预研项目(CBY19-YZ19);四川省医学科研青年创新课题(Q18042)。

摘　　要：目的:探讨T1期和T2期食管鳞癌根治术后淋巴结转移和预后影响因素及构建列线图预测模型。方法:采用回顾性队列研究方法。收集2014年1月至2019年12月川北医学院附属医院收治的672例T1期和T2期食管鳞癌患者的临床病理资料;男464例,女208例;年龄为(65±8)岁。患者均行根治性食管癌切除+二野或三野淋巴结清扫术。观察指标:(1)淋巴结清扫、转移及随访情况。(2)食管鳞癌根治术后淋巴结转移影响因素分析。(3)食管鳞癌根治术后预后影响因素分析。(4)食管鳞癌根治术后淋巴结转移及预后预测模型构建及评价。采用门诊、电话和网络问诊等方式进行随访,了解患者生存情况。随访时间截至2021年4月。正态分布的计量资料以 x±s表示,组间比较采用 t检验;偏态分布的计量资料以 M(范围)表示。计数资料以绝对数或百分比表示,组间比较采用 χ^(2)检验。采用Kaplan-Meier法计算生存率和绘制生存曲线。采用Log-Rank检验进行生存分析。食管鳞癌根治术后淋巴结转移的单因素和多因素分析采用Logistic回归模型,食管鳞癌根治术后预后的单因素和多因素分析采用COX回归模型。根据多因素分析结果构建食管鳞癌根治术后淋巴结转移和预后列线图预测模型,以受试者工作特征曲线(ROC)的曲线下面积(AUC)评价列线图预测模型的区分度,以校准曲线评价列线图预测模型的一致性。 结果:(1)淋巴结清扫、转移及随访情况。672例患者淋巴结清扫数目为(14±8)枚,淋巴结转移数目为2(1~19)枚。672例患者中,182例发生淋巴结转移,其中T1期和T2期分别为58例和124例。672例患者均获得术后随访,随访时间为38(1~85)个月。672例患者平均生存时间为65个月,1、3、5年总生存率分别为89.0%、74.3%、66.0%。325例T1期和347例T2期患者平均生存时间分别为70个月和61个月;1、3、5年总生存率分别为95.0%、83.5%、73.4%和87.4%、69.Objective To investigate the influencing factors for lymph node metastasis and prognosis in stage T1 and T2 esophageal squamous cell carcinoma after radical surgery and construct nomogram prediction models.Methods The retrospective cohort study was conducted.The clinico-pathological data of 672 patients with T1 and T2 esophageal squamous cell carcinoma who were admitted to the Affiliated Hospital of North Sichuan Medical College from January 2014 to December 2019 were collected.There were 464 males and 208 females,aged(65±8)years.All patients under-went radical esophagectomy+2 or 3 field lymph node dissection.Observation indicators:(1)lymph node dissection,metastasis and follow-up.(2)risk factors for lymph node metastasis of esophageal cancer after radical resection.(3)prognostic factors of esophageal cancer after radical resection.(4)construction and evaluation of the prediction models of lymph node metastasis and prognosis of esophageal cancer after radical resection.Follow-up was conducted using outpatient examination,telephone and internet consultations to detect survival of patients up to April 2021.Measurement data with normal distribution were represented as Mean±SD,and comparison between groups was conducted using the t test.Measurement data with skewed distribution were represented as M(range).Count data were described as absolute numbers or percentages,and comparison between groups was conducted using the chi-square test.Kaplan-Meier method was used to calculate survival rate and draw survival curve.Log-Rank test was used for survival analysis.Logistic regression model was used for univariate and multivariate analyses of risk for lymph node metastasis,and COX regression model was used for univariate and multivariate analyses of prognosis.Based on the results of multi-variate analysis,the nomogram prediction models for lymph node metastasis and prognosis predic-tion were constructed.The prediction discrimination of the nomogram models were evaluated using the area under curve(AUC)of the receiver operat

关 键 词：食管肿瘤 鳞癌 淋巴结转移 预后 列线图 

分 类 号：R735.1[医药卫生—肿瘤]