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目的对比分析农村与城市、低发区与高发区食管癌患者淋巴结转移的特征。方法 58 503例食管鳞癌患者均来自郑州大学河南省食管癌重点开放实验室1973年至2015年50万例食管癌和贲门癌临床信息数据库。采用χ~2检验和多因素Logistic回归分析淋巴结转移影响因素。结果 58 503例食管鳞癌患者中,男37 338例,年龄(59±9)岁;女21 165例,年龄(60±9)岁。农村患者淋巴结阳性率高于城市患者(39.3%vs 37.3%,P=0.011),低发区患者淋巴结阳性率明显高于高发区患者(40.0%vs 38.6%,P=0.001),男性患者淋巴结转移阳性率明显高于女性患者(40.8%vs 36.2%,P=0.000)。依淋巴结转移阳性数,将患者分为4组(N_0:0枚,N1:1~3枚,N2:4~6枚,N_3:>7枚),男性患者淋巴结转移阳性率均高于女性患者(N_1:24.0%vs 23.0%,N_2:13.2%vs 10.8%,N_3:3.2%vs 2.4%;P<0.001),低发区患者淋巴结转移阳性率也明显高于高发区(P<0.001),但农村和城市患者淋巴结转移阳性率相似。多因素Logistic回归分析显示:男性[OR=1.212,P<0.001,95%CI(1.717~1.255)]、低发区[OR=1.057,P=0.002,95%CI(1.021~1.094)]和农村[OR=1.108,P=0.002,95%CI(1.039~1.182)]是淋巴结转移的危险因素。结论低发区、农村、男性患者是食管癌发生淋巴结转移的危险因素。
Objective To compare and analyze the characteristics of lymph node metastasis in esophageal cancer patients in rural and urban areas, low incidence areas and high incidence areas. Methods A total of 58 503 esophageal squamous cell carcinoma patients were from 500,000 cases of esophageal and cardia cancer clinical information database from Zhengzhou Key Laboratory of Esophageal Cancer in Henan Province from 1973 to 2015. Χ ~ 2 test and multivariate logistic regression analysis were used to analyze the influencing factors of lymph node metastasis. Results Of 58,503 esophageal squamous cell carcinoma patients, 37 338 were male, with an average age of 59 ± 9 years and 21,165 women aged 60 ± 9 years. The positive rate of lymph node in rural patients was higher than that in urban patients (39.3% vs 37.3%, P = 0.011). The positive rate of lymph nodes in low incidence area was significantly higher than that in high incidence area (40.0% vs 38.6%, P = 0.001) The positive rate was significantly higher in female patients (40.8% vs 36.2%, P = 0.000). According to the number of positive lymph node metastasis, the patients were divided into 4 groups (N0: 0, N1: 1-3, N2: 4-6, N3:> 7). The positive rate of lymph node metastasis in male patients was higher than that in female patients (P <0.001). The positive rate of lymph node metastasis in low incidence area was significantly higher than that in high incidence area (P <0.001), and the positive rate of lymph node metastasis in low incidence area was significantly higher than that in high incidence area (N_1: 24.0% vs 23.0%, N_2: 13.2% vs 10.8%, N_3: 3.2% vs 2.4% However, the positive rates of lymph node metastasis in rural and urban patients were similar. Multivariate logistic regression analysis showed that there was no significant difference between male and female (OR = 1.212, P <0.001,95% CI 1.717-1.255), low incidence area (OR = 1.057, P = 0.002, 95% CI 1.01-1.094) [OR = 1.108, P = 0.002, 95% CI (1.039-1.182)] was a risk factor for lymph node metastasis. Conclusions Low incidence area, rural area and male patients are the risk factors of lymph node metastasis in esophageal cancer.