SiewertⅡ型和Ⅲ型食管胃结合部腺癌的淋巴结转移规律

目的探讨SiewertⅡ、Ⅲ型食管胃结合部腺癌（AEG）的淋巴结转移规律。方法回顾性分析2003年1月至2007年12月大连医科大学附属第一医院收治的152例SiewertⅡ、Ⅲ型AEG患者的临床资料，比较两者的临床病理特征、手术治疗相关资料及淋巴结转移规律。自患者首次入院开始随访，出院后采用电话随访。随访时间截至2012年12月或死亡时间。无序资料分析采用，检验，有序资料分析采用秩和检验，应用Kaplan-Meier法绘制生存曲线，组间生存率比较采用Log-rank检验。结果152例AEG患者中，行R。切除138例，R，、R2切除14例。总体R。切除率为90．79％（138／152）。SiewertⅡ、Ⅲ型AEG患者R。切除率分别为92．6％（63／68）和89．3％（75／84）。SiewertⅡ型AEG以第1、2、3、7、8a和110组淋巴结转移为主，其转移率分别为63．6％、56．4％、54．5％、47．3％、23．6％和23．6％；其次为第11、111和9组淋巴结转移，其转移率分别为16．4％、16．4％和12．7％。SiewertⅡ型AEG以第1、2、3、7、8a、4sb、11、4sa、4d组淋巴结转移为主，其转移率分别为60．6％、57．7％、50．7％、46．5％、28．2％、26．8％、23．9％、19．7％、11．3％；其次为第9、10、5、6组淋巴结转移，其转移率分别为19．7％、16．9％、14．1％和12．7％。SiewertⅡ型AEG患者第4sa、4sb、4d、5、6、10、11组淋巴结转移率低于SiewertⅢ型AEG患者，而第110、111组淋巴结转移率高于Siewert111型AEG患者，两者比较，差异有统计学意义（∥=2．132，4．271，8．317，2．801，6．143，7．327，7．491；8．014，5．386，P〈0．05）。145例患者获得随访，随访率为95．39％（145／152）。选取其中137例行R。切除的患者进行生存评估，其中SiewertlI型AEG患者63例、SiewertⅢ型AEG患者74例。SiewertⅡ、Ⅲ型AEG患者5年生存率分别为52．4％和40．5％，两者生存率比较，差异有统计学意义（，=3．419，P〈0．05）。SiewertⅡ型AEG无淋巴结转移者5年生存率为80．8％，有淋巴结转移者为32．4％，两者比较，差异有统计学意义（∥=14．185，P〈0．05）。SiewertⅢ型AEG无淋巴结转移者5年生存率为75．0％，有淋巴结转移者为27．8％，两者比较，差异有统计学意义（，=13．043，P〈0．05）。结论SiewertⅡ型AEG以第1、2、3、7、8a、110组淋巴结转移为主，其次为第11、111、9组淋巴结转移。SiewertⅡ型AEG以第1、2、3、7、8a、4sb、11、4sa、4d组淋巴结转移为丰．其次为第9、10、5、6鲳淋巴结转移。

Pattern of lymphatic metastasis of Siewert type H and HI adenocarcinoma of the esophagogastric junction

Objective To investigate the pattern of lymphatic metastasis of Siewert type II and m adeno- carcinoma of the esophagogastric junction （AEG）. Methods The clinical data of 152 patients with Siewert type ]I and m AEG who were admitted to the First Affiliated Hospital of Dalian Medical University from January 2003 to December 2007 were retrospectively analyzed. The follow-up began at the first admission, and ended at Decem- ber 2012 or the death of patients. Patients were followed up via phone call. The unordered data were analyzed using the chi-square test, and the ordered data were analyzed using the analysis of variance. The survival curve drawn using the Kaplan-Meier method, and the comparison of survival rates was done by Log-rank test. Results Of the 152 patients, 138 received Ro resection, 14 received R1 or R2 resection. The overall Ro resection rate was 90.79% （138/152）. The R0 resection rates of patients with Siewert type I] , m AEG were 92.6% （63/68） and 89.3% （75/84）. For Siewert type lI AEG, the incidences of lymphatic metastasis were high in No. 1 （63.6%）, No. 2 （56.4%）, No. 3 （54.5%）, No. 7 （47.3%）, No. 8a （23.6%） and No. 110 （23.6%） lymph nodes, and then followed by No. 11 （ 16.4% ）, No. 111 （ 16.4% ） and No. 9 （ 12.7% ） lymph nodes. For Siewert typellI AEG, the incidences of lymphatic metastasis were high in No. 1 （60.6%）, No. 2 （57.7%）, No. 3 （50.7%）, No. 7 （46.5%）, No. 8a （28.2%）, No. 4sb（26.8%）, No. 11 （23.9%）, No. 4sa （19.7%）, No. 4d （11.3%） lymph nodes, and then followed by No. 9 （ 19.7% ）, No. 10 （ 16.9% ）, No. 5 （ lg. 1% ） and No. 6 （ 12.7% ） lymph nodes. The metastatic rates of No. 4sa, 4sb, 4d, 5, 6, 10 and 11 lymph nodes of Siewert type I] AEG were significantly lower than those of Siewert type HI AEG, while the metastatic rates of No. 110 and 111 lymph nodes of Siewert type 11 AEG were significantly higher than those of Siewert type I~ AEG （X2 = 2. 132, 4. 271, 8. 317, 2. 801,6. 143, 7. 327,7. 491 ; 8.014, 5. 386, P 〈0.05）. A total of 145 patients were followed up, with the follow-up rate of 95.39% （145/152）. One hundred and thirty-seven patients with R0 resection were selected for survival evaluation, including 63 patients with Siewert type II AEG and 74 with Siewert type llI AEG. The 5-year survival rate of Siewert type 11 AEG patients was 52.4% , which was significantly higher than 40.5% of Siewert type m AEG patients （X2= 3. 419, P 〈 0.05）. The 5-year survival rates of Siewert type U AEG patients with and without lymph node metastasis were 32.4% and 80.8% , with significant difference （X2 = 14. 185, P 〈 O. 05）. The 5-year survival rates of Siewert type m AEG patients with and without lymph node metastasis were 27.8% and 75.0%, with significant difference （X2 = 13. 043, P 〈 0.05 ）. Conclusions For Siewert type II AEG, lymph node metastasis is mostly seen in No. 1, 2, 3, 7, 8a, 110 lymph nodes, and followed by No. 11, 111 and 9 lymph nodes; for Siewert type HI AEG, lymph node metastasis is mostly seen in No. 1, 2, 3, 7, 8a, 4sb, 11,4sa, 4d lymph nodes, and then followed by No. 9. 10. 5. 6 lymph nodes.