食管中下段鳞癌颈部淋巴结转移的危险因素分析及诊断模型构建

颜朝阳; 徐同欣; 徐新建; 尤杨; 何明

doi:10.12354/j.issn.1000-8179.2022.20220551

食管中下段鳞癌颈部淋巴结转移的危险因素分析及诊断模型构建

doi: 10.12354/j.issn.1000-8179.2022.20220551

颜朝阳^1,,
徐同欣²,
徐新建¹,
尤杨²,
何明^1, ,

1.
河北医科大学第四医院胸外科（石家庄市050000）
2.
CT室

基金项目: 本文受河北省医学科学研究计划项目（编号：20220132）资助

详细信息

作者简介:
颜朝阳：专业方向为胸部肿瘤的诊治

通讯作者:
何明 heming6699@sina.com

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出版历程
- 收稿日期: 2022-04-14
- 录用日期: 2022-05-25
- 修回日期: 2022-05-13
- 网络出版日期: 2022-06-15

Analysis of risk factors for cervical lymph node metastasis in middle and lower esophageal squamous cell carcinoma and construction of a diagnostic model

1.
Department of Thoracic Surgery
2.
Department of CT&MRI, The Fourth Hospital of Hebei Medical University, Shijiazhuang 050000, China

Funds: This work was supported by the Medical Science Research Project Program of Hebei Province (No. 20220132)

More Information

Corresponding author: Ming He; E-mail: heming6699@sina.com

摘要

摘要: 目的探讨食管中下段鳞癌颈部淋巴结转移的危险因素并构建诊断模型，为临床选择合理手术方式提供参考。方法选取2015年1月至2020年6月于河北医科大学第四医院行食管癌根治术+三野淋巴结清扫的240例食管中下段鳞癌患者作为观察对象，依据术后病理分为颈部淋巴结转移组和颈部淋巴结无转移组。采用多因素Logistic 回归分析颈部淋巴结转移的独立危险因素，并建立诊断模型，应用受试者工作特征（ROC）曲线评估其诊断效能。结果 240例食管中下段鳞癌患者中有62例（25.8%）发生颈部淋巴结转移。Logistic回归分析结果显示，肿瘤最大径、食管旁淋巴结转移、喉返神经旁淋巴结转移和CT诊断颈部淋巴结转移是食管中下段鳞癌颈部淋巴结转移的独立危险因素。诊断模型为P=1/(1+exp(-(-3.764+0.361×肿瘤最大径+1.281×食管旁淋巴结转移+1.614×喉返神经旁淋巴结转移+1.155×CT诊断颈部淋巴结转移)))，其阴性预测值为89.89%，阳性预测值为45.16%，准确度为78.33%。ROC曲线分析显示，ROC 曲线下的面积为0.827（95%CI ：0.767～0.886），约登指数为0.530，灵敏度和特异度分别为70.97%和82.02%。结论肿瘤最大径、食管旁淋巴结转移、喉返神经旁淋巴结转移和CT诊断颈部淋巴结转移是食管中下段鳞癌颈部淋巴结转移的独立危险因素，以此为基础建立的诊断模型具有一定的临床运用价值。
- 食管中下段鳞癌 /
- 颈部淋巴结转移 /
- 危险因素 /
- ROC曲线
Abstract: Objective To investigate the risk factors of cervical lymph node metastasis in middle and lower esophageal squamous cell carcinoma and construct a diagnostic model to provide clinical strategies for the rational selection of surgical methods. Methods A total of 240 patients with middle and lower esophageal squamous cell carcinoma, who underwent radical esophagectomy and three-field lymph node dissection at The Fourth Hospital of Hebei Medical University from January 2015 to June 2020 were selected as the observation subjects. According to the postoperative pathology, the patients were assigned into the cervical lymph node metastasis group and non-cervical lymph node metastasis group. Multivariate Logistic regression was used to analyze the independent risk factors of cervical lymph node metastasis, and receiver operating characteristic (ROC) curve was used to evaluate the diagnostic performance. Results Among 240 patients, 62 (25.8%) had cervical lymph node metastasis. Multivariate Logistic regression analysis revealed that the largest tumor diameter, paraesophageal lymph node status, recurrent laryngeal nerve lymph node status, and cervical lymph node metastasis status diagnosed by computed tomography (CT) were independent risk factors for cervical lymph node metastasis in middle and lower esophageal squamous cell carcinoma. The diagnostic model: P=1/(1+exp(-(-3.764+ 0.361× largest tumor diameter+1.281×paraesophageal lymph node status+1.614×recurrent laryngeal nerve lymph node status+1.155×cervical lymph node metastasis status diagnosed by CT))). The negative and positive predictive values were 89.89% and 45.16%, respectively. The area under the ROC curve of the diagnostic model constructed according to the independent risk factors was 0.827 (95%CI: 0.767–0.886), and the Youden index was 0.530, corresponding to a sensitivity and specificity of 70.97% and 82.02%, respectively. Conclusions The largest tumor diameter, paraesophageal lymph node status, recurrent laryngeal nerve lymph node status, and cervical lymph node metastasis status diagnosed by CT are independent risk factors for cervical lymph node metastasis of middle and lower esophageal squamous cell carcinoma. The diagnostic model established on this basis has a certain clinical application value.
- middle and lower esophageal squamous cell carcinoma /
- cervical lymph node metastasis /
- risk factors /
- ROC curve

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图 1 食管中下段鳞癌颈部淋巴结转移诊断模型的ROC曲线

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表 1 两组患者的临床资料比较 n（%）

临床特征	颈部淋巴结无转移组（n=178）	颈部淋巴结转移组（n=62）	χ²/t	P
性别			1.498^*	0.280
男	114（64.0）	45（72.6）
女	64（36.0）	17（27.4）
年龄（岁）	61.7±6.8	60.3±6.2	1.365^**	0.091
肿瘤位置			0.892^*	0.390
中段	133（74.7）	50（80.6）
下段	45（25.3）	12（19.4）
肿瘤最大径（cm）	3.3±1.5	4.3±1.8	−4.155^**	<0.001
肿瘤分化程度			2.989^*	0.220
高分化	30（16.8）	5（8.1）
中分化	100（56.2）	37（59.7）
低分化	48（27.0）	20（32.2）
T分期（期）			22.984^*	<0.001
pT1	56（31.5）	4（6.4）
pT2	33（18.5）	7（11.3）
pT3	74（41.6）	38（61.3）
pT4	15（8.4）	13（21.0）
脉管瘤栓			9.662^*	0.005
有	14（7.9）	14（22.6）
无	164（92.1）	48（77.4）
神经受侵			3.876^*	0.070
有	24（13.5）	15（24.2）
无	154（86.5）	47（75.8）
食管旁淋巴结转移			25.537^*	<0.001
有	20（11.2）	25（40.3）
无	158（88.8）	37（59.7）
纵隔淋巴结转移			30.985^*	<0.001
有	15（8.4）	24（38.7）
无	163（91.6）	38（61.3）
腹部淋巴结转移			6.811^*	0.011
有	46（25.8）	27（43.5）
无	132（74.2）	35（56.5）
喉返神经旁淋巴结转移			35.389^*	<0.001
有	41（23.0）	40（64.5）
无	137（77.0）	22（35.5）
CT诊断颈部淋巴结转移			13.488^*	<0.001
有	31（17.4）	25（40.3）
无	147（82.6）	37（59.7）
切除方式			1.690^*	0.240
R0	173（97.2）	58（93.5）
R1	5（2.8）	4（6.5）
：χ²检验；*：t检验

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表 2 颈部淋巴结转移的多因素Logistic回归分析

因素	β	OR	95%CI	P
肿瘤最大径	0.301	1.351	1.061～1.721	0.015
T分期	0.288	1.334	0.848～2.100	0.213
脉管瘤栓	0.289	1.336	0.483～3.700	0.577
食管旁淋巴结转移	1.082	2.950	1.271～6.844	0.012
纵隔旁淋巴结转移	0.907	2.476	0.979～6.262	0.056
腹部旁淋巴结转移	−0.165	0.848	0.373～1.926	0.693
喉返神经旁淋巴结转移	1.320	3.745	1.809～7.754	<0.001
CT诊断颈部淋巴结转移	0.972	2.644	1.195～5.852	0.016
常数项	−4.237	−	−	−

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表 3 食管中下段鳞癌颈部淋巴结转移的诊断模型

因素	β	OR	95%CI	P
肿瘤最大径	0.361	1.435	1.147～1.796	0.002
食管旁淋巴结转移	1.281	3.602	1.654～7.841	0.001
喉返神经旁淋巴结转移	1.614	5.023	2.530～9.970	<0.001
CT诊断颈部淋巴结转移	1.155	3.175	1.491～6.763	0.003
常数项	−3.764	−	−	−

下载: 导出CSV

表 4 诊断模型的评价 n （%）

颈部淋巴结转移实际结果	颈部淋巴结转移预测结果
颈部淋巴结转移实际结果	无	有
无	160	34
有	18	28

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