胸段食管癌术后下颈部淋巴结转移规律及放疗靶区探讨

目的 分析胸段食管癌二野淋巴结清扫术后下颈部淋巴结转移规律,为术后放疗靶区勾画提供参考。方法 搜集本院2004—2009年收治的 126例胸段食管癌术后区域淋巴结转移患者的临床资料,参照Som等颈部影像学分区将下颈部分为Ⅰ区(上纵隔淋巴结)、Ⅱ区(脏器淋巴结)、Ⅲ_a区(颈内静脉内淋巴结)、Ⅲ_b区(颈内静脉外淋巴结)、Ⅳ区(锁骨上淋巴结)、Ⅴ区(颈后三角淋巴结),并分析各区淋巴结转移情况。组间比较采用χ²检验,Logistic回归分析各区间淋巴结转移关系。结果 全组 126例区域淋巴结转移患者下颈部淋巴结转移占68.3%(86例),Ⅰ、Ⅱ、Ⅲ_a区淋巴结转移之和占下颈部淋巴结转移的95%(82例),其中Ⅰ、Ⅱ区占85%(73例)。右颈部淋巴结转移多于左颈部(53.2%∶30.2%,χ²=13.73,P=0.000),右侧Ⅰ、Ⅱ、Ⅲ_a区淋巴结转移比例均高于左侧(43.7%∶15.1%、17.5%∶7.1%、17.5%∶5.6%,χ²=24.79、6.22、8.77,P=0.000、0.013、0.003)。结论 胸段食管癌下颈部淋巴结转移主要集中于喉返神经旁(Ⅰ、Ⅱ区)与颈内静脉内(Ⅲ_a区)淋巴结。

Metastatic characteristics of lymph node in cervical region and radiotherapy target volume after dissection of thoracic esophageal carcinoma

Objective To investigate the metastatic characteristics of cervical lymph node in thoracic esophageal cancer of two-field lymph node dissection after radical surgery and to provide evidence for postoperative radiotherapy. Methods Local-regional lymph node metastasis after surgery of 126 cases with esophageal squamous cell carcinoma from 2004 to 2009 were reviewed. Boundaries of cervical lymph node were according to Som,s imaging-based nodal classification system. Enumeration data were compared by χ²test, and the risk factors of lymph node metastasis were analyzed with Logistic regressive model. Results
Lymph node metastasis rate of cervical region was up to 68.3% in all the cases with local-regional lymph node metastasis (86/126), and lymph node metastasis rate in levelⅠwas higher than those in the other levels (43.7%, 55/126). There was obvious difference in lymph node metastasis rate between the right and the left cervical region (53.2% vs 30.2%,χ²=13.73,P=0.000). Moreover, the results also shown that lymph node metastasis rate was notably increased in levelⅠ, Ⅱ and Ⅲ_a of the right compared with those of the left, showing statistical significance (43.7%∶15.1%,17.5%∶7.1%,17.5%∶5.6%,χ²=24.79,6.22,8.77,P=0.000,0.013,0.003).The sum of lymph node metastasis rate was 95%(82/86) in para-recurrent nerve and medial jugular vein, and 85%(73/86) in para-recurrent nerve. In addition, multivariate analysis showed that lymph node metastasis in levelⅠwas high risk factor for lymph node metastasis of levelⅡ. Conclusions Lymph node metastasis of cervical region mainly focused on para-recurrent nerve and medial jugular vein.