气管隆突上食管癌气管支气管侵犯的预测因素

Riedel M, Stein H J, Mounyam L, Busch R, Siewert J R

Pneumologie der 1. Medizinischen Klinik und Poliklinik, Klinikum rechts der Isar, Technische Universität, München, Deutschland.

Respiration. 2000;67(6):630-7. doi: 10.1159/000056292.

BACKGROUND

Factors possibly predicting airway invasion of oesophageal cancer in the absence of frank oesophagotracheal fistulas have not been studied.

OBJECTIVES

To identify possible predictors of airway invasion by oesophageal cancer that are readily accessible in the preoperative setting.

METHODS

We prospectively investigated 148 patients with newly diagnosed oesophageal cancer located at or above the level of the tracheal bifurcation and without any evidence of oesophago-respiratory fistulas or distant metastases. Demographic variables, respiratory parameters, results of bronchoscopy and other staging procedures (oesophagoscopy, swallow oesophagography, endosonography, CT and histology) and findings at surgery were compared between the patients with (n = 30) and without (n = 118) proven airway invasion and entered into a stepwise logistic regression model to evaluate their independent predictive roles.

RESULTS

Univariate analysis indicated that the incidence of airway invasion increased with the presence of suspect CT findings, the presence of respiratory symptoms, tumour length, T stage on endoscopic ultrasonography, and histopathologic grading of the primary cancer. A multivariate logistic regression model indicated that suspect CT findings (odds ratio, 4.4; 95% confidence interval 1.7-11.1, p = 0.002) and maximal tumour length >8 cm (odds ratio, 3.7; 95% confidence interval 1.4-9.6, p = 0.007) were associated independently with airway invasion. The accuracy of predicting airway invasion was 82.5% with both variables combined.

CONCLUSIONS

The high incidence of airway involvement by oesophageal cancer and the difficulty to predict it accurately with clinical data or other staging procedures justifies the routine use of bronchoscopy in all patients with the tumour located at or above the level of the tracheal bifurcation. A particular effort to objectively prove or exclude airway invasion should be made in patients with tumours longer than 8 cm and/or with CT findings suggesting airway invasion.

背景

在没有明显食管气管瘘的情况下，可能预测食管癌气道侵犯的因素尚未得到研究。

目的

确定术前易于获得的、可能预测食管癌气道侵犯的因素。

方法

我们前瞻性地研究了148例新诊断的位于气管隆突水平及以上且无食管呼吸道瘘或远处转移证据的食管癌患者。比较了有（n = 30）和无（n = 118）经证实气道侵犯的患者的人口统计学变量、呼吸参数、支气管镜检查及其他分期检查（食管镜检查、吞咽食管造影、内镜超声、CT和组织学）结果以及手术所见，并将其纳入逐步逻辑回归模型以评估其独立预测作用。

结果

单因素分析表明，气道侵犯的发生率随着可疑CT表现的出现、呼吸道症状的存在、肿瘤长度、内镜超声检查的T分期以及原发癌的组织病理学分级而增加。多因素逻辑回归模型表明，可疑CT表现（比值比，4.4；95%置信区间1.7 - 11.1，p = 0.002）和最大肿瘤长度>8 cm（比值比，3.7；95%置信区间1.4 - 9.6，p = 0.007）与气道侵犯独立相关。两个变量联合预测气道侵犯的准确率为82.5%。