食管癌合并HIV感染/AIDS患者临床特征及淋巴结转移的危险因素分析  

Clinical Characteristics of Patients with Esophageal Carcinoma Combined with HIV Infection/AIDS and Their Risk Factors for Lymph Node Metas⁃tasis

作　　者：王宁 李刚 李丹 龚胜 袁晔 周君 陈朝琼 姚晓军 Wang Ning;Li Gang;Li Dan;Gong Sheng;Yuan Ye;Zhou Jun;Chen Zhaoqiong;Yao Xiaojun(Department of Thoracic Surgery,Public Health Clinical Center of Chengdu,Chengdu 610061,Sichuan,China;School of Public Health,Chengdu Medical College,Chengdu 610083,Sichuan,China)

机构地区：[1]成都市公共卫生临床医疗中心胸外科,成都610061 [2]成都医学院公共卫生学院,成都610083

出　　处：《肿瘤预防与治疗》2024年第4期328-334,共7页Journal of Cancer Control And Treatment

基　　金：成都市医学科研课题(编号:2021089)。

摘　　要：目的:分析食管癌合并人类免疫缺陷病毒(human immunodeficiency virus,HIV)感染/艾滋病(acquired immune deficiency syndrome,AIDS)患者的临床特征及淋巴结转移的危险因素。方法:本研究回顾性分析2020年11月至2022年12月在成都市公共卫生临床医疗中心胸外科接受手术治疗的食管癌合并HIV感染/AIDS患者的临床资料,总结该人群的食管癌临床特征,分析淋巴结转移的影响因素。结果:本研究共纳入33例患者,平均年龄为(60.39±10.09)岁。其中男性占93.94%(31/33),女性占6.06%(2/33),有饮酒史患者占75.75%(25/33)。HIV感染/AIDS患者发生淋巴结转移患者54.54%(18/33),清扫淋巴结转移率为10.30%(65/631)。单因素分析发现,肿瘤最大径、临床分期、浸润深度、脉管癌栓、CD4^(+)T淋巴细胞计数、HIV病毒载量、术前血清白蛋白水平与淋巴结转移发生有关(均P<0.05);多因素Logistic回归分析显示:CD4^(+)T淋巴细胞计数<200 cells/μL、病毒载量≥20 copies/mL,术前血清白蛋白<35 g/L为食管癌合并HIV感染/AIDS患者发生淋巴结转移的独立危险因素(均P<0.05)。结论:HIV感染/AIDS的食管癌患者病毒载量高、免疫受损严重及营养状况低下时,容易发生淋巴结转移。该部分人群的治疗周期中,联合控制病毒载量、改善患者免疫、纠正营养不良及肿瘤综合治疗尤为关键。Objective:To analyze the clinical characteristics of patients with esophageal carcinoma combined with human immunodeficiency virus(HIV)infection/acquired immune deficiency syndrome(AIDS)and their risk factors of lymph node metastasis.Methods:This study retrospectively analyzed the clinical data of patients with esophageal cancer combined with HIV infection/AIDS who underwent surgery at the department of thoracic surgery in Public Health Clinical Center of Chengdu from November 2020 to December 2022,summarized the clinical characteristics of esophageal carcinoma in this population,and analyzed the factors affecting lymph node metastasis.Results:A total of 33 patients were included in this study,with a mean age of(60.39±10.09)years.93.94%(31/33)of the patients were male,6.06%(2/33)were fe⁃male,and 75.75%(25/33)had a history of alcohol consumption.54.54%(18/33)of the patients with HIV infection/AIDS had lymph node metastasis,and the rate of cleared lymph node metastasis was 10.30%(65/631).Univariate analysis revealed that the maximum diameter of the tumour,clinical stage,depth of infiltration,lymphovascular tumor embolus,CD4^(+)T lymphocyte count,HIV viral load and preoperative serum albumin were associated with the occurrence of lymph node metastasis(P<0.05).Multivariate logistic regression analysis showed that CD4^(+)T lymphocyte count<200 cells/μL,viral load≥20 copies/mL,and preoperative serum albumin<35 g/L were independent risk factors for lymph node metastasis in esophageal cancer patients with HIV infection/AIDS(P<0.05).Conclusion:Esophageal carcinoma patients with HIV in⁃fection/AIDS are prone to lymph node metastasis when they have high viral loads,severe immune compromise and low nutri⁃tional status.Control of viral load,improvement of patients’immunity and malnutrition,and comprehensive cancer treatment are particularly critical in the treatment cycle of the population.

关 键 词：食管癌 人类免疫缺陷病毒 艾滋病 淋巴结转移 危险因素 

分 类 号：R512.91[医药卫生—内科学] R655.4[医药卫生—临床医学] R735.1