食管癌淋巴结转移特点及其危险因素

目的 探讨食管癌淋巴结转移情况及其危险因素,为外科手术行淋巴结清扫提供参考。方法回顾总结2006年1月至2010年12月在复旦大学附属肿瘤医院胸外科行三野淋巴结清扫食管癌根治术308例患者的临床资料．分析淋巴结的转移规律及特点。结果308例患者平均清扫淋巴结（35．6±14．5）枚,197例（64％）患者出现淋巴结转移。Logistic单因素分析结果显示,脉管（淋巴管及血管）侵犯（P=0．019）及肿瘤浸润深度（P〈0．001）是发生淋巴结转移的危险因素。各站淋巴结中,胸部气管旁淋巴结转移率最高（25．0％）。上段食管癌腹部淋巴结转移率显著低于中段或下段食管癌（P=0．001）,而各段食管癌颈胸部淋巴结转移率比较,差异无统计学意义（P〉0．05）。颈胸部和颈胸腹部淋巴结转移率分别为14．6％和11．0％,而颈腹部和胸腹部则分别为3．6％和4．9％。脉管侵犯（P〈0．001）和胸部气管旁淋巴结转移（P=0．014）是食管癌发生颈部淋巴结转移的危险因素。结论食管癌淋巴结转移具有上、下双向和跳跃性的特点．胸部气管旁淋巴结转移可作为行颈部淋巴结清扫的指征。     

胸段食管鳞癌淋巴结转移规律探究

目的探讨胸段食管鳞癌淋巴结转移规律及其影响因素,以指导淋巴结清扫方式。方法回顾分析漳州市医院2010年4月至2012年7月手术治疗的328例胸段食管鳞癌的临床病理资料,探讨淋巴结转移规律及其影响因素。结果全组328例共清扫淋巴结9937枚,平均30．3枚／例。共437枚、153例有淋巴结转移,转移率46．65％;其中喉返神经旁淋巴结转移18．30％,10．46％喉返神经旁淋巴结为唯一转移部位。胸段食管癌淋巴结转移与肿瘤部位、长度、分化程度及浸润深度明显相关。胸上段食管癌淋巴结转移方向主要向上纵隔及下颈部;胸中段食管癌颈、胸、腹均可发生淋巴结转移;胸下段食管癌主要向腹腔、中下纵隔转移。结论食管上段鳞癌,颈部淋巴结转移率高,应行三野淋巴结清扫;下段食管癌清扫重点在腹腔、中下纵隔;中段鳞癌应提倡进行个体化清扫和适度清扫;分化程度差,浸润程度深的病例应适当扩大清扫范围。胸段食管癌喉返神经旁淋巴结转移率高,均应行喉返神经旁淋巴结清扫。     

Location and clinical impact of solitary lymph node metastasis in patients with thoracic esophageal carcinoma

BACKGROUND: The location and clinical impact of solitary lymph node metastasis from thoracic esophageal carcinoma have not been evaluated sufficiently. METHODS: A consecutive series of 91 patients with a solitary positive lymph node who underwent curative surgery for thoracic esophageal carcinoma was investigated. The prognostic impact was evaluated by univariate analysis and multivariate analysis using Cox's proportional hazards model. RESULTS: A total of 52 (57%) of the 91 patients showed a solitary positive node beyond the thorax. While 29% of the patients with an upper thoracic tumor showed a cervical node, 13% of the patients with a middle tumor and none of the patients with a lower tumor showed a cervical node. Tumor depth and venous invasion were found to be independent risk factors for poor survival. CONCLUSIONS: The solitary positive lymph nodes were broadly distributed depending on the tumor location and tumor depth. Tumor depth and venous invasion were risk factors for poor survival in these patients.     

Clinical outcomes of extended esophagectomy with three-field lymph node dissection for esophageal squamous cell carcinoma

OBJECTIVE: Opinions are conflicting about 3-field lymph node dissection (3FLND) during esophagectomy for esophageal cancer. In the current study, we sought to determine the prevalence of cervical and upper thoracic lymph node metastasis in patients with squamous cell carcinoma of the thoracic esophagus and to determine the impact of 3FLND on mortality, morbidity, survival, and recurrence rate. MATERIALS AND METHODS: Among 287 patients with squamous cell carcinoma of the thoracic esophagus seen between November 1985 and December 2001, 141 (49%) underwent extended esophagectomy with 3FLND (cervical, mediastinal, and abdominal lymph node dissection). Patients were observed and clinicopathologic information collected prospectively on all patients until death or August 2002. The median follow-up was 41 months, ranging from 10 to 173 months. RESULTS: Hospital mortality and morbidity rates were 6.4% and 80%, respectively. Thirty-four of 70 node-positive patients had cervicothoracic nodal involvement. Sixteen patients (11%) had nodal involvement confined only to the cervicothoracic nodes, and no patients with lower thoracic esophageal carcinoma showed cervicothoracic involvement alone. The frequency of cervical nodal disease was correlated with nodal status within the mediastinum (P <0.01). The 1-, 3-, and 5-year overall survival rates for all 141 patients were 76%, 58%, and 48%, respectively. Among significant variables verified by univariate analysis, independent prognostic factors for overall survival determined by multivariate analysis were number of lymph node metastasis (P <0.01), amount of blood transfusion (P <0.05), length of operation (P <0.05), and presence of pulmonary complications (P <0.05). CONCLUSIONS: Extended esophagectomy with 3FLND can be performed with an acceptable mortality. Metastases frequently involved the upper thoracic and cervical lesions, and cervical nodal disease was correlated with thoracic nodal status. 3FLND proved to be an important staging system in 11% of patients. An excellent overall survival suggests a superiority of 3FLND when performed at experienced centers.     

Risk factors for late cervical lymph node metastases in patients with stage I or II carcinoma of the tongue

BACKGROUND: Many histopathologic parameters in squamous cell carcinoma of the tongue have been identified as predictive factors for cervical lymph metastasis. However, predictive factors for occult cervical lymph node metastases and the criterion for elective therapy remain inconclusive. This study analyzed the clinicopathologic factors associated with late cervical lymph node metastases in patients with carcinoma of the tongue. METHODS: The clinicopathologic features of 50 consecutive patients seen between January 1985-December 1996 with previously untreated stage I or II squamous cell carcinoma of the tongue were reviewed. All patients were treated with partial glossectomy without elective neck dissection. Their mean age was 54.5 y (range, 23-90 y) and the male-female ratio was 1.2:1 (27 men and 23 women); 30 cases were stage I, and 20 cases were stage II. Clinicopathologic factors were analyzed to determine factors predicting late cervical lymph node metastasis. RESULTS: The overall cervical lymph node metastasis rate was 14.0% (7 of 50). Clinicopathologic factors significantly associated with the development of cervical lymph node metastasis were tumor size (> or =30 mm), tumor depth (> or =4 mm), differentiation, mode of invasion, microvascular invasion, and histologic grade of malignancy. In a multivariate logistic regression analysis, moderately differentiated squamous cell carcinoma of the tongue with tumor depth > or =4 mm had predictive value for late cervical lymph node metastasis and diminished overall survival (odds ratio, 10.0; p =.02; hazards ratio, 7.0; p =.039). CONCLUSIONS: The findings of this study demonstrate tumor depth > or =4 mm moderately differentiated squamous cell carcinoma of the tongue have a substantially higher rate of late cervical metastases. In the basis of these data, it is our recommendation that this be used in the decision to electively treat the neck.     

中央区淋巴结转移强度对甲状腺乳头状癌颈侧区淋巴结转移的临床意义

目的:应用中央区淋巴结转移（central lymph node metastasis,CLNM）强度概念,探讨甲状腺乳头状癌（papillary thyroid carcinoma,PTC）颈侧区淋巴结转移（lymph node metastasis,LNM）危险因素及对其影响。方法:回顾性分析内蒙古医科大学附属医院...     

Pattern of lymph node metastases in patients with squamous cell carcinoma of the thoracic esophagus who underwent three-field lymphadenectomy

BACKGROUND/AIMS: Lymph nodes in patients with squamous cell carcinoma of the thoracic esophagus might be involved with metastases at cervical, mediastinal, and abdominal sites. The range of lymph node dissection is still controversial. The pattern of lymph node metastasis and factors that are correlated with lymph node metastasis affect the surgical procedure of lymph node dissection. The purpose of the present study was to explore the pattern of lymph node metastasis and factors that are correlated with lymph node metastasis in patients with esophageal cancer who underwent three-field lymphadenectomy. METHODS: Lymph node metastases in 230 patients who underwent radical esophagectomy with three-field lymphadenectomy were analyzed. The metastatic sites of lymph nodes were correlated with tumor location by chi-square test. Logistic regression was used to analyze clinicopathological factors related to lymph node metastasis. RESULTS: Lymph node metastases were found in 133 of the 230 patients (57.8%). The average number of resected lymph nodes was 25.3 +/- 11.4 (range 11-71). The proportions of lymph node metastases were 41.6, 19.44, and 8.3% in neck, thoracic mediastinum, and abdominal cavity, respectively, for patients with upper thoracic esophageal carcinomas, 33.3, 34.7, and 14%, respectively, in those with middle thoracic esophageal carcinomas, and 36.4, 34.1, and 43.2%, respectively, for patients with lower thoracic esophageal carcinomas. We did not observe any significant difference in lymph node metastatic rates among upper, middle, and lower thoracic carcinomas for cervical or thoracic nodes. The difference in lymph node metastatic rates for nodes in the abdominal cavity was significant among upper, middle, and lower thoracic carcinomas. The lower thoracic esophageal cancers were more likely to metastasize to the abdominal cavity than tumors at other thoracic sites. A logistic regression model showed that depth of tumor invasion and lymphatic vessel invasion were factors influencing lymph node metastases. CONCLUSIONS: Based on our data, cervical and mediastinal node dissection should be performed independent of the tumor location. Abdominal node dissection should be conducted more vigorously for lower thoracic esophageal cancers than for cancers at other locations. Patients with deeper tumor invasion or lymphatic vessel invasion were more likely to develop lymph node metastases.     

Experimental study of lymph node metastasis in thoracic esophageal carcinoma--regarding lymph node metastasis and changes in lymphatic flow by ultrafine charcoal in rabbit esophageal carcinoma model]

Esophageal carcinoma models were created by transplanting VX2 cells to rabbit esophagus endoscopically. By injecting finely divided activated charcoal into normal rabbit esophagus and tumor sites of esophageal carcinoma model, lymph flow was observed directly. Existence of lymph node metastasis was studied in detailed pathology. In 30 rabbits with upper esophageal carcinoma, lymph node metastasis was seen in 77%. Metastasis to bilateral intrathoracic paratracheal lymph node was seen in 50%, and also concentration of lymphatic flows from tumor site was seen. However, there were no metastasis and no lymph flow to abdominal lymph nodes. While, metastasis to cervical lymph nodes showed around 13%. Esophageal lymphatic flows were also seen reaching the cervical area along the esophagus. In 40 models with mid lower esophageal carcinoma, lymph node metastasis were seen in 88%. Metastasis to right and left thoracic paratracheal lymph nodes was 75% and 53%, respectively, and 25% of metastasis went to cardia lymph nodes. The lymph flows were going up and down around these lymph nodes, and reaching to lymph nodes at upper highest mediastinum or left gastric artery. The metastatic rate to the cervical lymph nodes was about 5%. There were no significant differences in lymphatic metastasis between right and left mediastinum. These findings suggest the necessity of radical dissection for both sides of the mediastinum.     

胸段食管癌淋巴结转移特点的临床研究

目的 探讨胸段食管癌淋巴结转移的规律和特点,从而为其手术入路和淋巴结清扫范围提供参考.方法 回顾性分析2009年1月至2012年12月间中南大学湘雅医学院附属肿瘤医院胸外科收治的72例胸段食管癌患者的临床资料,所有病例均行右胸入路手术. 记录各组淋巴结的清扫及转移情况,并分析淋巴结转移的影响因素.结果 72例患者中,有48例出现淋巴结转移,淋巴结转移率为66.7％;清扫淋巴结总数为1495枚,转移181枚,淋巴结转移度为12.1％,平均每例清扫淋巴结20.8枚.在各组淋巴结中,右喉返神经旁（1R组）淋巴结转移率最高,达30.6％（22/72）.左喉返神经旁淋巴结（2L组、4L组和5组） 转移率为12.5％（9/72）.淋巴结转移率与肿瘤大小和浸润深度有关（均P＜0.05）,而与病变部位和分化程度无关（P＞0.05）.结论 胸段食管癌淋巴结转移以右喉返神经旁淋巴结转移为主,故其手术最佳入路应是右胸入路,淋巴结清扫则应以右、左喉返神经旁淋巴结为重点的系统纵隔、腹野淋巴结清扫.     

Oncological issues in staging mediastinal lymph node metastasis for left lung cancer

ObjectiveWe aimed to discuss the underlying oncological issues in staging of mediastinal lymph node metastasis in patients with left lung cancer who underwent extended radical lymphadenectomy (ERL).MethodsThis multi-institutional retrospective study analyzed 116 patients with left non-small-cell lung cancer who underwent bilateral paratracheal lymph node dissection (ERL) via median sternotomy. The clinicopathological records of patients with mediastinal lymph node metastasis were examined for prognostic factors, including age, sex, histology, tumor size, cN number, preoperative data, metastatic stations (number and distribution), pT, and adjuvant chemotherapy.ResultsMediastinal lymph node metastases were found in 43 patients, and right paratracheal lymph node metastases (pN3) were found in 13 patients. The 5-year overall survival rate was 25.2% in patients with pN3 tumors (n = 13) and 23.1% in patients with pN2 tumors (n = 30). The prognosis did not differ between patients with pN3 and pN2. Univariate analyses showed that histology, cN, and adjuvant chemotherapy were significant prognostic factors in patients with mediastinal lymph node metastasis. In these 43 patients, cN and adjuvant chemotherapy were significant independent prognostic factors in multivariate analysis.ConclusionsThe prognostic factors for left lung cancer with mediastinal lymph node metastasis were cN status and adjuvant chemotherapy, and not pN status (pN2 or pN3). We hope that the study results, which suggest that there may be no difference in prognosis between pN2 and pN3, would broaden the discussion of oncological issues in the staging of mediastinal lymph node metastasis of left lung cancer.     

Retropharyngeal node metastasis from papillary thyroid carcinoma

BACKGROUND: Papillary thyroid carcinomas commonly metastasize to paratracheal and jugular lymph nodes. Metastasis to the retropharyngeal node is rare for this tumor. METHODS: Five patients underwent surgical treatment for metastasis of thyroid papillary carcinoma to the retropharyngeal lymph nodes that presented as a parapharyngeal or retropharyngeal mass. All patients had a history of total or subtotal thyroidectomy as their initial treatment. Among them, 3 patients had undergone ipsilateral modified radical neck dissection at their initial treatment. The other 2 patients had a history of bilateral or ipsilateral modified neck dissection for their subsequent cervical lymph node metastases. RESULTS: Metastatic retropharyngeal nodes were successfully resected via transcervical approach in all patients. Although aspiration and difficulty in swallowing were observed in 2 patients after surgical treatment for metastatic retropharyngeal nodes, these complications spontaneously resolved within a few months. CONCLUSIONS: This study suggests that neck dissection and/or metastatic cervical lymph nodes might alter the direction of lymphatic drainage to the retrograde fashion, resulting in the unusual metastasis to the retropharyngeal lymph nodes. Although the cases described here are rare, metastasis to the retropharyngeal node should be considered at the follow-up for thyroid papillary carcinoma. Because these metastases will be missed by routine ultrasonography of the neck, periodic CT scan or MRI is recommended for follow-up, especially for patients with a history of neck dissection.     

Diagnosis of lymph node metastasis in esophageal carcinoma: detecting with coronal magnetic resonance imaging

To assess the utility of MR imaging in diagnosis of lymph node metastasis, the author studied 70 patients with histologically proved esophageal squamous cell carcinoma. Coronal spin echo imaging (SE400/40) was the most available method in the mediastinum and using this method, lymph nodes were clearly imaged along trachea and vessels of the mediastinum in its long axis. The 250 lymph nodes from 44 patients who underwent laparotomy, thoracotomy and cervical dissection, were reviewed for findings by coronal MRI. Detectability of lymph nodes was 141/250 (56%) in total. Cervical and paraesophageal nodes were unable to detect well, but paratracheal, subcarinal, hilar nodes, supraclavicular nodes which are clinically important region for lymph node dissection of esophageal surgery were well-detected. Distinction between metastatic and non-metastatic nodes was studied on its size and its location. The supraclavicular and paratracheal nodes larger than 1.5 cm in diameter were involved in cancer invasion for the most part.     

Patterns of lymph node metastasis in 3-field dissection for carcinoma in the thoracic esophagus

Lymph node metastasis is well-known as the most important prognostic indicator for esophageal carcinomas, and an accurate assessment of positive metastasis can only be made after total lymphadenectomy around the esophagus. However, prior to the development of 3-field lymph node dissection in Japan, no such operation existed for ascertaining the full positivity distribution. We report herein the results of a restrospective study conducted on 70 patients who underwent subtotal esophagectomy with 3-field dissection to discover the patterns of lymph node metastasis from carcinoma in the thoracic esophagus. Lymph node metastases tended to have an orderly spreading pattern in relation to the tumor location, even though the lymph node metastasis varied widely from the lower neck to the upper abdomen. The nodes along the right recurrent nerve and the paracardiac nodes were most frequently found to be positive for metastasis. In contrast, no metastasis was found in the internal jugular nodes, the pretracheal nodes, the common hepatic nodes, or the splenic nodes. Patients with carcinoma in the upper thoracic esophagus rarely had metastasis in the abdominal nodes, while those with carcinoma in the lower thoracic esophagus rarely had metastasis in the cervical nodes. Thus, surgical extirpation of the lymph nodes during 3-field dissection is effective not only to determine the correct tumor staging for the planning of adequate adjuvant therapies postoperatively, but also to produce a guideline for prospective lymphadenectomy for esophageal carcinomas.     

T2胸中段食管鳞癌淋巴结转移特点和规律

目的 探讨T2胸中段食管鳞癌淋巴结转移特点和规律.方法 分析246例接受颈、胸、腹三野淋巴结清扫的T2胸中段食管鳞癌病人的临床病理指标与淋巴结转移的关系.结果 每例病人清扫淋巴结15～59枚,平均25枚.其中129例存在区域淋巴结转移.颈、胸和腹三区淋巴结转移率分别为28.9%、28.5%和22.0%,差异无统计学意义.Logistic回归模型显示肿瘤长度、肿瘤细胞分化程度及有无淋巴管血管浸润是影响淋巴结转移的有意义因素.结论 T2胸中段食管鳞癌淋巴结转移与肿瘤长度、肿瘤细胞分化程度及有无淋巴管血管浸润明显相关;T2胸中段食管鳞癌有上、下双向转移和跳跃性转移的特点,应行三野淋巴结清扫,对胸中段超出T2的食管鳞癌也应行以上手术.

Abstract：

Objective To investigate the pattern of lymph node metastasis in patients with 17 and middle thoracic esophageal squamous cell carcinoma( ESCC). Methods Retrospective review the clinical data of 246 cases with T2 and middle thoracic esophageal squamous cell carcinoma who were treated by three-field lymphadenectomy. Analyze the relationship between clinical pathological factors and lymph node metastasis. Results Lymph node metastases were found in 129 of the 246 patients (52.4% ).The average number of resected lymph nodes was 25 per patient (rangel5 -59). The rates of lymph node metastasis were 28.9% in the neck, 28.5% in thoracic mediastinum and 22.0% in abdominal cavity for patients with T2 and middle thoracic ESCC. No significant difference in lymph node metastasis' rate was observed among the neck, thoracic mediastinum and abdominal cavity. Logistic-regression showed the length of tumor, tumor cell differentiation and angiolymphatic invasion were factors influencing lymph node metastasis. Conclusion Lymph node metastasis in T2 and middle thoracic ESCC has the characteristics of upward, downward and skip spreading. Patients with T2 and middle thoracic ESCC should be treated with radical surgery with three-field lymphadenectomy.     

CT检查淋巴结短径评估胸段食管鳞癌左侧喉返神经旁淋巴结转移的应用价值

目的探讨CT检查淋巴结短径评估胸段食管鳞癌左侧喉返神经旁淋巴结转移的应用价值。方法采用回顾性描述性研究方法。收集2009年10月至2016年12月2家医疗中心收治的628例(中山大学肿瘤防治中心236例、郑州大学附属肿瘤医院392例)胸段食管鳞癌病人的临床病理资料;男462例,女166例;中位年龄为62岁,年龄范围为38~85岁。观察指标:(1)手术情况和左侧喉返神经旁淋巴结清扫及转移情况。(2)CT检查左侧喉返神经旁淋巴结短径评估术后左侧喉返神经旁淋巴结转移效能。(3)最佳截断值确定。(4)不同诊断标准的检测情况。偏态分布的计量资料以M(范围)表示。计数资料以绝对数或百分比表示。以受试者工作特征曲线(ROC)的曲线下面积(AUC)评估检测方法的效能。约登指数最大值对应最佳截断点。结果(1)手术情况和左侧喉返神经旁淋巴结清扫及转移情况:628例病人中,572例行二野淋巴结清扫,56例行三野淋巴结清扫;408例行微创手术,220例行开放手术。628例病人中,60例发生左侧喉返神经旁淋巴结转移。628例病人共清扫左侧喉返神经旁淋巴结1666枚,其中左侧喉返神经旁淋巴结转移75枚,转移率为4.502%(75/1666)。(2)CT检查左侧喉返神经旁淋巴结短径评估术后左侧喉返神经旁淋巴结转移效能:CT检查左侧喉返神经旁淋巴结短径预测左侧喉返神经旁淋巴结转移的AUC为0.854(95%可信区间为0.792~0.916,P<0.05)。(3)最佳截断值的确定:分别以CT检查左侧喉返神经旁淋巴结短径为5、6、7、8、9、10 mm作为最佳截断值,其对应的约登指数分别为0.556、0.384、0.258、0.063、0.003。确定CT检查左侧喉返神经旁淋巴结短径5 mm为最佳截断值。(4)不同诊断标准的检测情况:分别以CT检查左侧喉返神经旁淋巴结短径≥5 mm和≥10 mm作为胸段食管鳞癌左侧喉返神经旁淋巴结转移的诊断标准,两者灵敏度、特异度、准确度、阳性预测值、阴性预测值、漏诊情况分别为66.3%和5.0%、92.3%和99.8%、89.5%和90.7%、46.3%和75.0%、96.0%和90.9%、20和57例。结论CT检查淋巴结短径可用于评估胸段食管鳞癌左侧喉返神经旁淋巴结转移。以淋巴结短径≥5 mm作为胸段食管鳞癌左侧喉返神经旁淋巴结转移标准时,灵敏度、特异度和准确度较好。     

N1期食管鳞癌淋巴结转移规律及预后分析

目的：探讨N1期食管鳞癌淋巴结转移规律及其与预后的关系。方法回顾性分析2005年1月至2008年12月间天津医科大学肿瘤医院行食管癌根治术且术后病理诊断为N1期（1～2枚淋巴结转移）的126例患者的临床及随访资料,分析各组淋巴结转移情况及其对预后的影响。结果126例患者中仅1枚淋巴结转移者70例,2枚淋巴结转移者56例。上纵隔淋巴结、中下食管旁淋巴结、贲门周围淋巴结和胃左动脉旁淋巴结的早期转移率较高,分别为53．8％（14/26）、38．3％（41/107）、34．5％（30/87）和36．8％（39/106）。隆突下淋巴结转移（P＝0．031）和中下食管旁淋巴结转移（P＝0．042）是影响食管鳞癌早期淋巴结转移患者的独立预后因素。隆突下淋巴结转移者5年生存率明显低于其他部位淋巴结转移者（8％比26％,P＝0．004）;而仅中下食管旁淋巴结转移者5年生存率则明显高于其他部位淋巴结转移者（33％比12％,P＝0．029）。结论 N1期食管鳞癌淋巴结易转移至上纵隔、中下食管旁、贲门周围和胃左动脉旁淋巴结等部位,而隆突下及中下食管旁淋巴结转移是N1期患者的独立预后因素。     

Surgical outcome after the clearance of abdominal metastatic lymph nodes in 138 patients with thoracic esophageal carcinoma

BACKGROUND: Although abdominal lymph node metastasis in patients with thoracic esophageal squamous cell carcinoma (SCC) has been reported to be a risk factor to reduce long-term survival, only a few studies have so far evaluated the clinicopathologic factors among this group of patients. The purpose of this study was to evaluate the patients' surgical outcome after the clearance of metastatic abdominal nodes. PATIENTS AND METHODS: From 1980 to 2002, 550 consecutive patients with thoracic esophageal SCC underwent surgery with an abdominal lymph node dissection. A total of 138 patients with abdominal lymph node metastases were curatively resected. Those patients, including 62 from 1980 to 1989 and 76 from 1990 to 2002, were retrospectively reviewed. Univariate and multivariate analyses were performed to evaluate the impact of clinicopathologic factors on the survival of these patients. RESULTS: The overall 5-year survival rate of the 138 patients with abdominal lymph node metastases was 23%. A univariate analysis revealed that the following groups showed a greater than 30% overall 5-year survival rate: patients with T1 or T2 tumors, patients without thoracic node metastases, and those with poorly differentiated type tumors. Good prognostic factors based on a multivariate analysis were the most recent time period of surgery and 4 or fewer positive nodes. CONCLUSION: Among the patients with abdominal lymph node metastases, those with T1 or T2 tumors, patients without thoracic node metastases, and patients with 4 or fewer positive nodes showed an acceptable overall survival after a curative resection.     

胸中段食管鳞状细胞癌伴腹腔淋巴结转移及其预后的临床研究

目的 了解胸中段食管鳞状细胞癌伴腹腔淋巴结转移的方式,分析预后的影响因素.方法 对1998年1月至2003年1月接受手术治疗的368例胸中段食管鳞状细胞癌患者进行回顾性研究.本组男性289例,女性79例,年龄38～79岁,平均56岁.术前临床分期I～Ⅲ期.全部患者采用Ivor-Lewis手术(右胸及上腹部两切口)行食管大部切除加胸腹二野淋巴结清扫.全组患者平均随访时间68个月.结果 腹腔淋巴结转移58例(15.8%),其中T1-2患者占36.2%(21/58);有13.8%(8/58)的患者为跳跃性腹腔淋巴结转移,均发生在T1-2患者中.腹腔淋巴结转移患者5年生存率为10.3%,低于胸腔淋巴结转移患者的18.3%.远处腹腔淋巴结转移患者预后极差,无1例达到5年生存(0/16).COX多因素分析结果 显示,淋巴结转移数目≥5枚和远处腹腔淋巴结转移是腹腔淋巴结转移患者的独立预后因素.结论 胸中段食管癌腹腔淋巴结转移的发生率较高,应该选择有利于腹腔淋巴结广泛清扫的手术方式.腹腔淋巴结转移患者的预后不良,尤其淋巴结转移数目较多和远处淋巴结转移的患者预后更差.     

胸段食管癌隆突下淋巴结转移影响因素分析

目的探讨胸管食管癌隆突下淋巴结的转移规律及相关影响因素。方法回顾性分析安阳肿瘤医院2015-06—2018-05间1402例行食管癌根治术患者的病例资料(淋巴结清扫包括隆突下淋巴结)。结果胸段食管癌隆突下转移发生率为8.35%,与患者的性别、年龄、病理类型及手术方式等无关(P>0.05);与肿瘤部位、浸润深度、淋巴结转移程度、分化程度、TNM分期、脉管癌栓、神经侵犯及术前治疗方法等有关(P<0.05)。结论胸段食管癌隆突下淋巴结转移率较高,但食管胸上段癌、cT1期的食管癌患者隆突下淋巴结转移发生率较低,可行选择性清扫;胸中下段食管癌术中仍应作为淋巴结常规清扫部位。术前行放疗或同步放化疗后患者隆突下淋巴结转移发生明显降低,对局部晚期食管癌患者推荐术前放疗或同步放化疗。