摘要
目的 评估淋巴结转移数目和淋巴结转移率对食管癌根治性切除术后患者预后的影响。方法 回顾性分析2008年3月至2012年6月河南省肿瘤医院病理科阅片确诊的573例食管癌根治术后患者的临床病理资料。Kaplan–Meier计算累计生存率，Log–rank检验比较生存曲线，Cox风险比例模型进行多因素分析。计算受试者工作特征（ROC）曲线下面积（AUC）比较淋巴结转移数目和淋巴结转移率对食管癌预后的预测价值。结果 573例患者的1、3、5年累积生存率分别为72.5%、46.1%和32.3%。单因素分析显示，病变部位（P＝0.020）、肿瘤长度（P＝0.009）、肿瘤浸润深度（P＝0.011）、淋巴结转移数目（P〈0.01）、淋巴结转移率（P〈0.01）均对预后有影响。多因素Cox回归分析显示，肿瘤浸润深度（P＝0.047）、淋巴结转移数目（P＝0.018）和淋巴结转移率（P＝0.011）为影响患者预后的独立危险因素。ROC曲线显示淋巴结转移率（AUC＝0.680）较淋巴结转移数目（AUC＝0.579）对预后的评估更有价值（P＝0.029）。结论 淋巴结转移率和淋巴结转移数目可联合应用于食管癌患者术后阳性淋巴结转移程度及预后的评估。
Objective To investigate the number of metastatic lymph nodes （pN） and the metastatic lymph node ratio （LNR） on the post-surgical prognosis of patients with esophageal cancer （EC）.Methods A retrospective analysis of 573 inpatients diagnosed as esophageal carcinomas from March 2008 to June 2012 was carried out.All pathologic specimen were reviewed by pathologists from Henan Tumor Hospital.The Kaplan-Meier method was used to calculate survival rates, and survival curves were compared with the Log-rank test.The Cox model was employed for multivariate analyses of factors.The association of pN and LNR with prognosis of esophageal cancer was examined by the area under the ROC curve（AUC）.Results The 1-, 3- and 5-year OS rates were 72.5%, 46.1% and 32.3%, respectively.Univariate analysis showed that tumor location（P=0.020）, tumor length（P=0.009）, pT stage（P=0.011）, pN stage（P〈0.01）, and the LNR（P〈0.01） were prognostic factors for OS.Multivariate analysis indicated that pT stage（P=0.047）, pN stage（P=0.018） and LNR（P=0.011） were significant and independent risk factors for poor OS.ROC analysis indicated that LNR （AUC=0.680） had better predictive value than pN （AUC=0.579）.Conclusion The integrated use of LNR and pN may be suitable for evaluation of prognosis in patients with EC and positive nodal metastasis after curative resection.
出处
《中华医学杂志》
CAS
CSCD
北大核心
2016年第47期3829-3832,共4页
National Medical Journal of China
关键词
食管肿瘤
淋巴转移
预后
Esophageal neoplasms,Lymphatic metastasis,Prognosis
