胸段食管鱗癌患者膈肌旁淋巴結(jié)轉(zhuǎn)移的風(fēng)險因素和預(yù)后分析

胸段食管鱗癌患者膈肌旁淋巴結(jié)轉(zhuǎn)移的風(fēng)險因素和預(yù)后分析摘要：目的：本研究旨在分析胸段食管鱗癌患者膈肌旁淋巴結(jié)轉(zhuǎn)移的風(fēng)險因素和預(yù)后，并探討對其治療的啟示。

方法：回顧性分析2015年1月至2020年12月收治的胸段食管鱗癌患者，包括208例，其中膈肌旁淋巴結(jié)陽性70例，膈肌旁淋巴結(jié)陰性138例，比較兩組患者的臨床病理特征和預(yù)后。

結(jié)果：單因素分析表明，淋巴結(jié)轉(zhuǎn)移、腫瘤大小、深度、距離切緣遠(yuǎn)近以及TNM分期與膈肌旁淋巴結(jié)轉(zhuǎn)移有關(guān)，而性別、年齡、吸煙、飲酒和手術(shù)方式等因素則無關(guān)。多因素分析表明，淋巴結(jié)轉(zhuǎn)移、腫瘤大小、深度、距離切緣遠(yuǎn)近是影響膈肌旁淋巴結(jié)轉(zhuǎn)移的獨立因素。膈肌旁淋巴結(jié)陽性組與陰性組在總生存期和無進(jìn)展生存期方面差異顯著，膈肌旁淋巴結(jié)轉(zhuǎn)移是預(yù)后不良的獨立因素。

結(jié)論：淋巴結(jié)轉(zhuǎn)移、腫瘤大小、深度、距離切緣遠(yuǎn)近是胸段食管鱗癌患者膈肌旁淋巴結(jié)轉(zhuǎn)移的危險因素，膈肌旁淋巴結(jié)轉(zhuǎn)移是預(yù)后不良的獨立因素，手術(shù)治療是首選方法，根治性手術(shù)和淋巴結(jié)清掃可以明顯改善預(yù)后。

關(guān)鍵詞：胸段食管鱗癌、膈肌旁淋巴結(jié)轉(zhuǎn)移、風(fēng)險因素、預(yù)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