| 沈文斌,许金蕊,李曙光,李幼梅,宋春洋,赵彦,祝淑钗.阳性淋巴结对数比对食管癌术后患者不同辅助治疗疗效的评估作用[J].中华放射医学与防护杂志,2020,40(6):454-460 |
| 阳性淋巴结对数比对食管癌术后患者不同辅助治疗疗效的评估作用 |
| Effect of logarithmic ratio of positive lymph nodes on the efficacy of different adjuvant treatments for patients with esophageal cancer after surgery |
| 投稿时间：2019-04-19 |
| DOI：10.3760/cma.j.issn.0254-5098.2020.06.007 |
| 中文关键词: 食管肿瘤/食管鳞癌 手术治疗 阳性淋巴结对数比 辅助治疗 预后 |
| 英文关键词:Esophageal neoplasms/esophageal squamous cell carcinoma Surgical treatment Positive lymph node log ratio Adjuvant therapy Prognosis |
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| 中文摘要: |
| 目的 分析阳性淋巴结对数比（LODDS）对食管癌术后患者预后的影响，并分析LODDS对接受不同术后辅助治疗方案患者疗效评估的作用。方法 收集在河北医科大学第四医院接受治疗的1 546例食管癌术后患者，回顾性分析LODDS对患者预后的影响，并进一步分析LODDS对术后患者选择不同术后辅助治疗方案的意义。结果 全组患者1、3、5年总生存率分别为87.5%、61.7%和52.2%。受试者工作特征曲线（ROC）分析结果显示-1.354 1为LODDS最佳截点值。多因素分析结果显示，患者性别、年龄、病变部位、病变粘连程度、术后辅助治疗方式、pTNM分期和LODDS为影响患者预后的独立性因素（P<0.05）。不同治疗模式的3组患者进行1：1：1的倾向得分匹配法分析（PSM）后，每组205例，多因素分析结果显示，患者性别、病变粘连程度、术后辅助治疗方式、pTNM分期和LODDS为影响患者独立性预后因素（P<0.05）。分层分析结果显示，LODDS数值较小组患者接受术后辅助性治疗的OS优于单纯手术组患者（χ2=81.470、5.182，P<0.05），但术后化疗（POCT）与术后放化疗（POCRT）对患者预后的差异无统计学意义（P>0.05）；而在LODDS数值较大组显示POCRT组患者的OS优于其他两组（χ2=4.151、24.020，P<0.05），且POCT与POCRT两组患者之间差异有统计学意义（χ2=8.728，P<0.05）。结论 LODDS为食管鳞癌术后患者的独立性预后影响因素，并在一定程度上可以指导术后辅助治疗方式的选择。这一结论需要进一步临床研究证实。 |
| 英文摘要: |
| Objective To analyze the effect of positive lymph node log ratio (LODDS) on the prognosis of postoperative patients with esophageal cancer, and analyze the effect of LODDS on the evaluation of the efficacy of patients receiving different postoperative adjuvant treatment. Methods A total of 1 546 patients with esophageal cancer treated in the Fourth Hospital of Hebei Medical University were retrospectively analyzed. The effect of LODDS on the prognosis of patients was retrospectively analyzed. The significance of LODDS in choosing different treatment options for patients after operation was further analyzed. Results The 1-, 3- and 5-year survival rates were 87.5%, 61.7% and 52.2%, respectively. The result of area under curve(ROC)curve analysis show that -1.354 1 is the best cut-off point for LODDS. Multivariate analysis showed that gender, age, lesion location, degree of adhesion, adjuvant therapy, pTNM stage and LODDS were the independent factors affecting the patients (P<0.05).After propensity-matched analysis(PSM)analysis, there were 205 patients in each group. Multivariate analysis showed that gender, degree of adhesion, adjuvant therapy, pTNM stage and LODDS were independent prognostic factors (P<0.05).The result of stratified analysis showed that patients with small LODDS values had better prognosis (OS) in patients undergoing postoperative adjuvant therapy than patients in the surgery alone (χ2=81.470, 5.182, P<0.05), but postoperative chemotherapy (POCT) and postoperative radiotherapy and chemotherapy (POCRT) had no significant difference in the OS of patients (P>0.05). However, in the larger LODDS group, the OS of patients in the POCRT group was significantly better than the other two groups (χ2=4.151, 24.020, P<0.05), and there was also a significant difference between the POCT and POCRT groups (χ2=8.728, P<0.05). Conclusions LODDS is an independent prognostic factor for postoperative patients with esophageal squamous cell carcinoma and can guide the choice of postoperative adjuvant therapy to a certain extent. This conclusion needs further clinical research to confirm. |
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