Analysis of risk factors of lymph node metastasis of superficial esophageal cancer and its clinical application
10.3760/cma.j.issn.0254-1432.2018.07.005
- VernacularTitle:表浅型食管癌淋巴结转移相关危险因素分析和临床运用评估
- Author:
Xiaoran SHEN
1
;
Yini DANG
;
Weifeng ZHANG
;
Yu DONG
;
Yifeng ZHANG
;
Guoxin ZHANG
Author Information
1. 210029,南京医科大学第一附属医院消化科
- Keywords:
Superficial esophageal cancer;
Lymph node metastasis;
Risk factors;
Clinical value
- From:
Chinese Journal of Digestion
2018;38(7):445-450
- CountryChina
- Language:Chinese
-
Abstract:
Objective To investigate the risk factors of lymph node metastasis (LNM) in patients with superficial esophageal cancer (SEC) and to evaluate its clinical application.Methods From January 2010 to December 2016,769 SEC patients,who received surgery in the First Affiliated Hospital of Nanjing Medical University,were enrolled,and their clinical data were retrospectively analyzed.Chisquare test and logistic regression analysis were performed for statistical analysis.The sensitivity,specificity,and overall positive accuracy of pathological type and depth of invasion before operation were evaluated.Results The rate of LNM in patients with SEC was 15.34％ (118/769).There were significant differences in alcohol consumption,maximum tumor diameter,histological type,differentiation degree,depth of invasion and vascular invasion between patients with LNM (118 cases) and patients withoutLNM (651 cases) (x2=5.66,13.71,40.65,20.04,36.70 and 61.51;all P＜0.05).The results of multivariate analysis showed that maximum tumor diameter＞2 cm(odd ratio (OR) 1.76,95％ confidence interval (CI) 1.12 to 2.77),poor differentiation(OR 1.92,95％CI 1.23 to 3.01),submucosal invasion(OR 2.67,95％CI 1.28 to 5.56) and vascular invasion (OR 5.28,95％CI 2.75 to 10.13) were independent risk factors of LNM in patients with SEC.The tumor location was significantly correlated with the site of LNM (x2=107.05,P＜0.01).The sensitivity and specificity of preoperative assessment of LNM were 58 ％ (51/88) and 59 ％ (301/510),respectively.The overall positive accuracy of histological type before operation was 66.7％ (440/660).The overall positive accuracy of depth of invasion evaluated by endoscopic ultrasound before operation was 27.9％ (19/68).Conclusion Endoscopic treatment is recommended for SEC patients with maximum tumor diameter ≤ 2 cm,high ormoderate degree of differentiation,tumor confined to the mucosal layer and without vascular metastasis for the relatively low risk of LNM.
