胸段食管鳞癌淋巴结转移特点及临床意义

目的 了解胸段食管鳞癌淋巴结转移特点及对预后的影响，探讨合理的淋巴结清扫范围。方法 对２４３例单纯技术切除胸段食管鳞癌患者的临床资料进行回顾性分析。结果 淋巴结转移率４５．３％，转移度１０．５％，表现为沿食管周上的上下“双向性”转移。影响淋巴结转移的因素为肿瘤浸润深度和肿瘤分化，肿瘤长度则影响不大。有淋巴结转移的患者５年生存率为１６．４％，明显低于无淋巴结转移患者的５１．９％（Ｐ〈０．０１），。淋

Characteristics of lymph node metastasis of squamous cell carcinoma of thoracic esophagus and its clinical significance

OBJECTIVE: To study the characteristics of lymph node metastases of squamous-cell carcinoma of thoracic esophagus and its influence on patients' prognosis and find reasonable dissecting approaches of lymph nodes. METHODS: To analyse retrospectively the clinical materials of 243 patients who had undergone resection of squamous-cell carcinoma of thoracic esophagus. RESULTS: Lymph node metastases was found in 110 of the 243 treated patients (45.3%). In 3,813 lymph nodes dissected, metastases existed in 400 (10.5%). The cancer cells disseminated upward and downward to lymph nodes along the esophagus. Tumor differentiation and the depth of tumor invasion were factors influencing lymph node metastases, but the length of tumor was not. The 5-year survival rate of the patients with lymph node metastasis was 16.4%, being much lower than that of patients with no lymph node metastasis (51.9%). The numbers of lymph node metastases had little influence on patients' prognosis. CONCLUSION: Because of the different upward and downward spreading of esophageal cancer cells to the lymph nodes, different lymph node dissecting approaches should be taken. The thoracic, and abdominal regional (two fields) lymph nodes dissection could be appropriate to esophageal carcinoma of the lower thoracic segment, and the cervical, thoracic and abdominal (three fields) lymph node dissection should be done for patients with earlier esophageal carcinoma of upper or middle thoracic segments.