初始无转移食管鳞癌放化疗后淋巴结转移的临床分析

目的：分析可能影响临床无转移食管鳞癌患者接受根治性放（化）疗后出现淋巴结转移的因素。方法：选取2002年1月至2009年12月于河北医科大学第四医院放疗科接受治疗的263 例食管鳞癌患者，分析患者一般临床资料及肿瘤局部因素中可能影响患者治疗后出现淋巴结转移的因素。结果：全组263 例食管癌患者治疗后出现淋巴结转移31例（11.8%），其中18例为单纯淋巴结转移，余13例淋巴结转移患者伴有其他脏器转移和（或）食管复发。胸上段、胸中段及胸下段食管癌患者淋巴结转移分别为11例（13.3%）、13例（10.1%）及7 例（13.7%）。 单因素分析结果显示患者近期疗效、食管病变造影长度、病变最大横径及病变体积为影响患者治疗后出现淋巴结失败的因素（χ2= 7.597、9.717、5.361、4.815；P = 0.006、0.002、0.021、0.028）；Logistic多因素分析结果显示食管病变造影长度及近期疗效为患者治疗后出现淋巴结转移的独立影响因素（P = 0.004、0.026）。 结论：食管病变造影长度及即时疗效为影响临床无转移食管鳞癌患者接受根治性放（化）疗后出现淋巴结转移的主要因素。

Lymph node failure pattern after radiotherapy/chemotherapy in esophageal squamous cell carcinoma without initial clinical metastasis

Objective:To analyze the factors affecting lymph node failure pattern after radiotherapy/chemotherapy in esophageal squamous cell carcinoma without initial clinical metastasis. Methods:A total of 263 patients, who were diagnosed as thoracic esopha -geal carcinoma from January 2002to December 2009, were included in this retrospective study. Factors affecting lymph node failure pattern with general clinical data and tumor local factors were analyzed. Results:Among the 263 esophageal cancer cases,31(11 .8%) had lymph node metastasis after treatment, including18cases of simple lymph node metastasis and13other cases of lymph node metas-tasis with esophageal and other organ metastasis or recurrence. The numbers of cases for lymph node metastasis in the upper, middle, and lower thoracic esophagus were 11 (13.3%),13(10.1%), and7 (13.7%), respectively. Univariate analysis showed that recent cura-tive effect, length of tumor on X-rays, maximum tumor diameter, and tumor volume were the significant factors associated with lymph node metastasis ( χ2=7.597, 9.717, 5.361, and 4.815; P=0.006, 0.002, 0.021, and 0.028). Logistic regression analysis results showed that recent curative effect and length of tumor on X-rays were independent significant factors ( P=0.004 and 0.026). Conclusion:Recent cu -rative effect and length of tumor on X-rays were the significant factors associated with lymph node failure pattern after radiotherapy/ chemotherapy in esophageal squamous cell carcinoma without initial clinical metastasis.