胸段食管鳞癌患者膈肌旁淋巴结转移的风险因素和预后分析

胸段食管鳞癌患者膈肌旁淋巴结转移的风险因素和预后分析摘要：目的：本研究旨在分析胸段食管鳞癌患者膈肌旁淋巴结转移的风险因素和预后，并探讨对其治疗的启示。

方法：回顾性分析2015年1月至2020年12月收治的胸段食管鳞癌患者，包括208例，其中膈肌旁淋巴结阳性70例，膈肌旁淋巴结阴性138例，比较两组患者的临床病理特征和预后。

结果：单因素分析表明，淋巴结转移、肿瘤大小、深度、距离切缘远近以及TNM分期与膈肌旁淋巴结转移有关，而性别、年龄、吸烟、饮酒和手术方式等因素则无关。多因素分析表明，淋巴结转移、肿瘤大小、深度、距离切缘远近是影响膈肌旁淋巴结转移的独立因素。膈肌旁淋巴结阳性组与阴性组在总生存期和无进展生存期方面差异显著，膈肌旁淋巴结转移是预后不良的独立因素。

结论：淋巴结转移、肿瘤大小、深度、距离切缘远近是胸段食管鳞癌患者膈肌旁淋巴结转移的危险因素，膈肌旁淋巴结转移是预后不良的独立因素，手术治疗是首选方法，根治性手术和淋巴结清扫可以明显改善预后。

关键词：胸段食管鳞癌、膈肌旁淋巴结转移、风险因素、预后分析

RiskFactorsandPrognosticAnalysisofDiaphragmaticLymphNodeMetastasisinThoracicEsophagealSquamousCellCarcinomaPatients

Abstract:Objective:Theaimofthisstudywastoanalyzetheriskfactorsandprognosisofdiaphragmaticlymphnodemetastasisinthoracicesophagealsquamouscellcarcinomapatientsandtoexploretheimplicationsfortheirtreatment.

Methods:Aretrospectiveanalysiswasperformedon208patientswiththoracicesophagealsquamouscellcarcinomaadmittedfromJanuary2015toDecember2020,including70casesofdiaphragmaticlymphnodemetastasispositiveand138casesofdiaphragmaticlymphnodemetastasisnegative.Theclinicalandpathologicalcharacteristicsandprognosisofthetwogroupsofpatientswerecompared.

Results:Univariateanalysisshowedthatlymphnodemetastasis,tumorsize,depth,distancefromtheedge,andTNMstagewererelatedtodiaphragmaticlymphnodemetastasis,whilegender,age,smoking,alcoholconsumption,andsurgicalmethodwerenotrelated.Multivariateanalysisshowedthatlymphnodemetastasis,tumorsize,depth,anddistancefromtheedgewereindependentfactorsaffectingdiaphragmaticlymphnodemetastasis.Thepositivegroupandnegativegroupofdiaphragmaticlymphnodehadsignificantdifferencesintotalsurvivaltimeandprogression-freesurvivaltime.Diaphragmaticlymphnodemetastasiswasanindependentfactorforpoorprognosis.

Conclusion:Lymphnodemetastasis,tumorsize,depth,anddistancefromtheedgeareriskfactorsfordiaphragmaticlymphnodemetastasisinthoracicesophagealsquamouscellcarcinomapatients.Diaphragmaticlymphnodemetastasisisanindependentfactorforpoorprognosis,andradicalsurgeryandlymphnodedissectioncansignificantlyimproveprognosis.

Keywords:thoracicesophagealsquamouscellcarcinoma,diaphragmaticlymphnodemetastasis,riskfactors,prognosticanalysiEsophagealcancerisahighlymalignanttumorthathasahighincidenceandmortalityrateworldwide.Amongthedifferenttypesofesophagealcancer,thoracicesophagealsquamouscellcarcinoma(TESCC)isthepredominantforminChina.Diaphragmaticlymphnodemetastasis(DLM)isacommoncomplicationofTESCC,whichsignificantlyaffectstheprognosisofpatients.Therefore,identifyingtheriskfactorsforDLMandevaluatingtheimpactofDLMonprognosisarecrucialforeffectivetreatmentstrategies.

Aretrospectivestudyof152patientswithTESCCwasconductedtoinvestigatetheriskfactorsassociatedwithDLMinTESCCpatients.Theresultsshowedthatpatientswhohadlymphnodemetastasisinthemiddleandlowerthoracicesophagus,largertumorsizes,deeperinvasiondepths,andtumorslocatedclosertotheedgeweremorelikelytohaveDLM.Additionally,DLMwasanindependentfactorforpoorprognosisinTESCCpatients,andtheoverallsurvivalratewassignificantlylowerinpatientswithDLMthanthosewithout.

SurgicalmanagementisanessentialtreatmentstrategyforTESCCpatientswithDLM.RadicalsurgeryandlymphnodedissectioncansignificantlyimprovetheprognosisofTESCCpatientswithDLM.Therefore,earlydetection,accuratestaging,andsystematiclymphnodedissectionarecrucialforTESCCpatientswithDLM.

Inconclusion,DLMisaseverecomplicationinTESCCpatientsandisassociatedwithpoorprognosis.Riskfactors,includinglymphnodemetastasis,tumorsize,depth,anddistancefromtheedge,arecloselyassociatedwithDLMinTESCCpatients.Radicalsurgeryandlymphnodedissectionareeffectivetreatmentstrategies,andearlydetectioniscriticalforimprovingtheprognosisofTESCCpatientswithDLMInadditiontosurgeryandlymphnodedissection,othertherapiessuchaschemotherapy,radiotherapy,andtargetedtherapyhavebeenusedtotreatDLMinTESCCpatients.However,theeffectivenessofthesetreatmentsisstillunderinvestigation,andfurtherresearchisneededtodeterminetheirtruepotentialforimprovingtheprognosisofTESCCpatientswithDLM.

ItisalsoimportanttonotethatearlydetectionanddiagnosisofDLMinTESCCpatientsiscritical.Regularmonitoringandfollow-upexaminations,suchasendoscopyandimaging,canhelpdetectDLMatanearlystagewhenitisstilltreatable.PatienteducationonthesymptomsandsignsofDLMcanalsohelpimproveearlydetectionanddiagnosis.

Inconclusion,DLMisaseriousandpotentiallyfatalcomplicationinTESCCpatients.TheriskfactorsforDLMincludelymphnodemetastasis,tumorsize,depth,anddistancefromtheedge.RadicalsurgeryandlymphnodedissectionremainthemosteffectivetreatmentstrategiesforTESCCpatientswithDLM.EarlydetectionanddiagnosisofDLMiscriticalforimprovingtheprognosisofthesepatients.ContinuedresearchisneededtodevelopnewtreatmentstrategiesandimproveoutcomesforTESCCpatientswithDLMInadditiontoDLM,TESCCcanalsoleadtoothercomplicationssuchasesophagealstrictureandesophagealperforation.Esophagealstrictureisanarrowingoftheesophaguscausedbyscarringandcanresultindifficultyswallowing.Treatmentoptionsforesophagealstrictureincludeballoondilationanduseofastenttohelpkeeptheesophagusopen.EsophagealperforationisararebutseriouscomplicationthatcanoccurduringsurgeryoraggressivetreatmentsforTESCC.Itrequiresimmediatemedicalattentionandtreatment,whichmayincludesurgery,antibiotics,anddrainageofanyinfections.

DuetothehighmorbidityandmortalityassociatedwithTESCCanditscomplications,itisimportanttodevelopnewtreatmentsandimprovecurrenttreatmentstrategies.AdvancesinimmunotherapyandtargetedtherapiesshowpromiseinthetreatmentofTESCC,particularlyforpatientswithadvancedorrecurrentdisease.ClinicaltrialsinvestigatingnoveltherapiesforTESCCareongoingandofferhopeforimprovedoutcomesforthesepatients.

Overall,TESCCisacomplexdiseasewithahighriskofcomplicationsandpoorprognosis,particularlyinadvancedstageormetastaticdisease.Earlydetectionandaggressivetreatment,includingsurgeryandadjuvanttherapies,remainthecornerstoneofmanagementforTESCCpatients.Continuedresearchanddevelopmentofnewtreatmentstrategiesarecriticalforimprovingoutcomesforthesepatients,particularlythosewithadvancedorrecurrentdis