食管癌根治患者LODDS变化及3年预后状况评估  

Evaluation and analysis of lodds changes and 3-year prognosis in patients with radical resection of esophageal cancer

作　　者：吴小玲 卢航超 WU Xiaoling;LU Hangchao(Zhejiang Armed Police Corps Hospital,Zhejiang 310051,China)

机构地区：[1]中国人民武装警察部队浙江省总队医院,杭州310051 [2]浙江萧山医院

出　　处：《浙江创伤外科》2023年第9期1632-1635,1639,共5页Zhejiang Journal of Traumatic Surgery

摘　　要：目的 对食管癌根治患者阳性淋巴结对数比(LODDS)变化及3年预后状况评估及分析。方法 选取2015年1月至2020年1月在本院进行食管癌根治术的102例食管癌患者进行研究。患者进行食管癌根治术治疗后,进行3年以上的随访,根据患者3年以上的随访情况,利用受试者应用曲线(ROC)评估患者LODDS分期标准,将患者按照LODDS分期标准进行分组,用极限乘积法(Kaplan-Meier)对比患者LODDS分组后预后3年的生存分析,并利用对数秩检验法(Log-rank)比较组间生存率。同时,采用单因素logistic回归及Cox多因素分析法分析影响患者预后3年无疾病生存(DFS)的因素,并利用ROC曲线评估LODDS分期及淋巴结病理分类(PN)分期对患者3年预后DFS评价能力。结果 经ROC曲线分析,患者的LODDS分期的最佳截点值为-1.15,即在ROC曲线最佳截点值-1.15时患者的LODDS分期的约登指数最大,此时对患者生存影响的敏感度为74.3%,特异度为58.2%,曲线下面积为0.700,将患者按照LODDS分为LODDS≤-1.15组,LODDS>-1.15组;经预后3年的生存曲线分析,LODDS<-1.15组患者的生存期明显大于LODDS≥-1.15组,差异有统计学意义(P<0.05);经单因素logistic回归分析结果显示,年龄、性别、分化程度、手术清扫淋巴结个数、是否神经侵犯、病理类型、T分期、PN分期、LODDS分期与患者3年预后DFS相关,差异有统计学意义(P<0.05);经Cox分析结果显示,年龄、性别、分化程度、手术清扫淋巴结个数、是否神经侵犯、病理类型、T分期、PN分期、LODDS分期均是影响患者3年预后DFS的独立因素,(P<0.001);经ROC曲线对比分析,患者LODDS分期曲线下面积为0.700明显大于患者PN分期曲线下面积0.645,LODDS分期对患者3年预后DFS评价能力明显高于PN分期,差异有统计学意义(P<0.001)。结论 LODDS变化对食管癌根治患者3年预后状况评估及分析具有一定的意义,是评估患者3年预后DFS的独立因素,值得推广应用�Objective To evaluate and analyze the changes of logarithm ratio of positive lymph nodes(LODDS)and 3-year prognosis in patients with esophageal cancer.Methods 102 patients with esophageal cancer who underwent radical esophagectomy in our hospital from January 2015 to January 2020 were selected for study.The patients were followed up for more than 3 years after radical esophagectomy.According to the follow-up,the subject application curve(ROC)was used to evaluate the LODDS staging standard of patients,and the patients were grouped according to the LODDS staging standard.The survival analysis of 3 years after LODDS grouping was compared with the Kaplan Meier method,and the log rank test was used.At the same time,the factors affecting the prognosis of 3-year disease-free survival(DFS)were analyzed by univariate logistic regression and Cox multivariate analysis,and the evaluation ability of LODDS stage and lymph node pathological classification(PN)stage on 3-year DFS was evaluated by ROC curve.Results According to ROC curve analysis,the optimal cut-off point of PATIENTS'LODDS stage was-1.15,when the optimal cut-off point of ROC curve was-1.15,the Jorden index of patients'LODDS stage was the highest,and the sensitivity,specificity and area under the curve of patients were 74.3%,58.2%and 0.700,respectively.Patients were divided into LODDS≤-1.15 group and LODDS>-1.15 group according to LODDS.According to the analysis of 3-year survival curve,the survival time of patients in LODDS<-1.15 group was significantly higher than that in LODDS≥-1.15 group,and the difference was statistically significant(P<0.05).Univariate logistic regression analysis showed that age,gender,degree of differentiation,number of dissected lymph nodes,neurological invasion,pathological type,T stage,PN stage and LODDS stage were correlated with 3-year prognosis DFS,with statistical significance(P<0.05).Cox analysis showed that age,gender,degree of differentiation,number of dissected lymph nodes,nerve invasion,pathological type,T stage,PN stage and

关 键 词：食管癌根治术 阳性淋巴结对数比 3年预后 淋巴结病理分类 无疾病生存 

分 类 号：R735.1[医药卫生—肿瘤]