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目的探讨食管癌淋巴结转移数量与生存率的相关性及影响预后的危险因素。方法回顾性分析14 132例食管癌患者临床资料,有淋巴结转移5 930例为阳性组,无淋巴结转移8 202例为阴性组;阳性组依据淋巴结转移数量分为N1(1~2个区域淋巴结转移)3 210例、N2(3~6个区域淋巴结转移)1 654例、N3(≥7个区域淋巴结转移)1 066例;记录患者生存状况,分析年龄、性别、浸润深度、病理类型等与生存结局的关系,评价预后影响因素。结果阳性组1a生存率(43.66%)高于阴性组(14.12%),3、5a生存率(37.15%,19.19%)低于阴性组(45.39%、40.49%),差异均有统计学意义(P<0.01);阳性组N3患者1a生存率(82.46%)高于N2患者(59.79%)和N1患者(22.46%),差异均有统计学意义(P<0.05);单因素分析显示,年龄、浸润程度、分化程度、肿瘤部位、肿瘤直径与食管癌淋巴结转移有关,性别与淋巴结转移无关(P>0.05);多因素logistic回归分析显示,年龄>50岁(HR=2.850,P=0.004)、低分化程度(HR=2.160,P=0.001)、食管下段肿瘤(HR=2.040,P=0.000)、肿瘤直径>3cm(HR=1.620,P=0.000)是食管癌淋巴结转移的高危因素。结论食管癌淋巴结转移数量与患者生存状态有关;年龄>50岁、低分化程度、食管下段肿瘤、肿瘤直径>3cm是食管癌淋巴结转移的主要影响因素。
Objective To investigate the correlation between lymph node metastasis and survival rate in esophageal cancer and the risk factors affecting the prognosis. Methods The clinical data of 14 132 patients with esophageal cancer were retrospectively analyzed. There were 5 930 cases of lymph node metastasis as positive group and 8 202 cases of no lymph node metastasis as negative group. According to the number of lymph node metastasis, N1 (1 ~ 2 regional lymph node metastasis ) Had 3 210 cases, 1 654 cases with N2 (3 ~ 6 regional lymph nodes metastasis) and 1 066 cases with N3 (≥7 regional lymph nodes metastasis). The survival status of patients were recorded and the age, gender, depth of invasion, pathological type and survival were recorded Outcome, evaluation of prognostic factors. Results The survival rate of positive group 1a was significantly higher than that of negative group (43.66%, 14.12%, 35.15%, 19.19%, 45.39%, 40.49%, respectively) P <0.01). The survival rate of 1a in patients with positive N3 (82.46%) was significantly higher than that of patients with N2 (59.79%) and patients with N1 (22.46%, P 0. 01). Univariate analysis showed that age (P> 0.05) .Multivariate logistic regression analysis showed that age> 50 years old (HR = 2.850, P = 0.004), and there was no significant difference in lymph node metastasis between the two groups , Low degree of differentiation (HR = 2.160, P = 0.001), lower esophageal tumor (HR = 2.040, P = 0.000) and tumor diameter> 3cm (HR = 1.620, P = 0.000) were risk factors for lymph node metastasis in esophageal cancer. Conclusions The number of lymph node metastasis in esophageal cancer is related to the survival status of patients. The age of> 50 years, the poorly differentiated degree, the lower esophageal tumor and the tumor diameter> 3cm are the main influencing factors of lymph node metastasis in esophageal cancer.