Prognostic Correlation Analysis Of Patients With Underweight Esophageal Squamous Carcinoma

Objective:Esophageal carcinoma(EC)is one of the most common malignant tumors of the digestive system in the world and one of the most common causes of cancer-related death in the world.Clinically,nearly 90%of patients with esophageal squamous carcinoma account for about 90%.At present,the mainstream treatment for esophageal cancer is still surgery,and the comprehensive assessment of patients before surgery and the prevention and treatment of postoperative complications are the focus of surgical work.As a basic indicator for assessing nutritional status,body mass index(BMI)can affect many pathophysiological processes and even the occurrence and development of malignant tumors.As an important step in tumor assessment,lymph node assessment will determine the patient’s diagnosis and treatment plan and ultimately affect the patient’s prognosis.Therefore,systematic and comprehensive evaluation is the basic condition for surgical diagnosis and treatment of esophageal cancer.This study focuses on clinical practice,explores the clinical differences of patients with low BMI,and uses various clinical indicators of patients to construct a model for the prediction of lymph node metastasis and surgical complications of esophageal squamous carcinoma,so as to help surgeons improve the preoperative evaluation methods of patients with esophageal squamous carcinoma and predict the progress of the disease in time.Methods:Retrospective collection of patients with esophageal squamous cancer who underwent surgery for esophageal cancer surgery in the Affiliated Hospital of Yangzhou University from January 2 0 1 8 to December 2021.A systematic retrospective method was used to include 183 patients with esophageal squamous carcinoma surgery according to the nasal discharge criteria,which were divided according to the international body mass index international standard:underweight group(BMI<18.5kg/m2,40 cases);control group,(BMI>18.5kg/m2,143 cases).According to the postoperative pathology,lymph node metastasis is divided into two groups:the positive group(with lymph node metastasis,60 cases)and the negative group(no lymph node metastasis,123 cases).At the same time,according to the type of postoperative complications,it is divided into the pulmonary infection group(3 6 cases),the non-pulmonary infection group(147 cases),the anastomotic fistula group(26 cases)and the anastomotic fistula group(15 7 cases).The data is analyzed and studied using Chi-square Test,Mann-Whitney Test,t Test,and Logistic regression analysis.Results:Compared with non-small weight patients,there were significant differences in alcohol history(OR=3.605,95%Cl=1.670-7.782,P=0.001),tumor infiltration depth(OR=2.441,95%Cl=1.119-4.985,P=0.014),MCV(OR=1.098,95%Cl=1.019-1.183,P=0.014)were significantly different from the two groups.In addition,the lymph node positive group and the negative group analyzed the history of alcohol consumption(OR=2.143,95%Cl=1.059-4.335,P=0.034),tumor infiltration depth(OR=2.816,95%Cl=1.444-5.439,P=0.002),RTW(OR=24.749,95%Cl=1.600-382.792,P=0.022)are independent risk factors for lymph node metastasis of esophageal squamous carcinoma.The risk prediction model based on these three indicators is statistically significant.The area under the subject analysis(ROC)curve(AUC)is 0.700(95%C1:0.619-0.782,P<0.001).At the same time,in the analysis of postoperative complications,it is concluded that small weight(OR=3.486,95%Cl=1.582-7.681,P=0.002)and intrathoracic anastomosis(OR=2.589,95%Cl=1.183-5.669,P=0.017)are independent risk factors for lymph node metastasis in esophageal squamous cancer,and Lymphocyte-Monocyte ratio(LMR)is the protective factor for lung infection after esophageal squamous carcinoma(OR=0.774,95%Cl=0.615-0.974,P=0.029).Based on these three indicators,the prediction model established is meaningful.The area under the subject analysis(ROC)curve(AUC)curve(95%Cl:0.616-0.817,P<0.001).Finally,In the analysis of risk factors for anastomotic fistula,it is concluded that anastomotic position(operative mode)is an independent risk factor for anastomotic fistula after esophageal cancer(OR=9.130,95%Cl=1.199-69.504,P=0.033).Conclusion:Most small-weight patients with esophageal squamous carcinoma have a history of drinking alcohol in the past,and most of them have deep tumor infiltration.The average red blood cell volume(MCV)of low-weight patients is significantly different from that of non-small weight patients.On the other hand,the history of drinking,the deeper tumor infiltration depth,and the width of erythrocyte distribution(RDW)are independent risk factors for lymph node metastasis of esophageal squamous carcinoma.The prediction model based on these three indicators is statistically significant.At the same time,the prediction model of postoperative lung infection of esophageal squamous carcinoma based on three clinical indicators:intrathoracic anastomosis,small weight and LMR is statistically significant.The two sets of models have been tested by Hosmer-Lemeshow to have good fitting advantages.And finally we concluded that cervical anastomosis is an independent risk factor for anastomotic fistula after esophageal cancer surgery.