胸中段食管鳞癌淋巴结转移度及合理清扫范围的临床研究

目的:本研究通过分析胸中段食管鳞癌淋巴结转移规律及淋巴结转移度对预后的影响,探讨合理的淋巴结清扫范围.方法:对129例经现代二野淋巴结清扫术的胸中段食管鳞癌患者的临床资料进行回顾性分析.结果:全组患者淋巴结转移率为56.6%,总淋巴结转移度(阳性淋巴结数/清扫淋巴结总数,LMR)为11.3%,上纵隔淋巴结转移率为43.4%.最常见的淋巴结受累区域为食管旁、右喉返神经旁、贲门及胃左血管旁、隆突下.影响淋巴结转移的主要因素为肿瘤浸润深度、分化程度及肿瘤长度.无淋巴结转移组、淋巴结转移度≤20%组和淋巴结转移度>20%组患者5年生存率分别为50.4%、31.0%和6.8%,结果差异有统计学意义(P=0.000).结论:淋巴结转移度是判断食管癌预后的一个重要因素,胸中段食管癌应该常规行包括双侧上纵隔的现代二野淋巴结清扫术.

Clinical Study of Lymph Node Metastasis and Optimal Lymphadenectomy for Middle Third Thoracic Esophageal Squamous Cell Carcinoma

Objective: To explore the status of lymph node metastasis of middle third thoracic esophageal squamous cell carcinoma and its influence on the prognosis and to seek the reasonable range of lymphade-nectomy. Methods: A total of 129 patients who underwent curative esophagectomy with modern two-field lymphadenectomy of middle third thoracic esophageal squamous cell carcinoma were reviewed. Results: The lymph node metastasis rate was 56.6% and the upper mediastinal lymph node metastasis rate was 43.4%. The lymph node metastasis ratio (positive nodes/total dissected nodes, LMR) was 11.3%. Paraesophageal lymph nodes, lymph nodes near the right recurrent nerve, the left gastric and infracadnal lymph nodes were most commonly involved when the tumor was located in the middle thoracic esophagus. Tumor differentiation, the depth of tumor invasion and the length of tumor were influencing factors for lymph node metastasis. The 5-year survival of N_0, N_1 (LMR≤20%) and N_1 (LMR>20%) patients were 50.4%, 31.0% and 6.8%, respective-ly, with a significant difference among the three groups (P=0.000). Conclusion: LMR was one of the key fac-tors affecting the prognosis, of esophageal cancer. Patients with middle third thoracic esophageal carcinoma should be treated with radical surgery with modern two-field lymphadenectomy.