胸段食管癌孤立性淋巴结转移规律及其临床价值

探讨胸段食管癌孤立性淋巴结转移的规律及其临床价值，为指导食管癌淋巴结清扫范围提供理论依据。方法:回顾性分析66例发生孤立性淋巴结转移胸段食管癌病例的临床病理资料，探明孤立性淋巴结转移的常见部位，分析其与肿瘤所在部位、浸润深度的关系，并对本组患者预后进行单因素分析。结果:本组食管癌孤立性淋巴结中喉返神经旁、食管旁和胃周为淋巴结转移高发组，跳跃性淋巴结转移20例（30.3%）。浅表型食管癌孤立性淋巴结常集中分布于2～3个区域，而进展型广泛分布于颈、胸、腹各组淋巴结。孤立性淋巴结转移组与无转移组术后5年生存率分别为36.4%和42.8%，差异有统计学意义。跳跃性与非跳跃性淋巴结转移组术后5年生存率分别为35.0%和36.9%，差异无统计学意义。单因素分析发现，浸润深度是影响本组患者预后的独立因素。结论:胸段食管癌孤立性淋巴结分布与肿瘤部位、浸润深度密切相关，双侧喉返神经旁、食管旁及胃周淋巴结是其高发部位。 

Clinical Significance and Regularity of Solitary Lymph Node Metastasis in Thoracic Esophageal Carcinoma

To explore the pattern of solitary lymph node ( SLN ) metastasis and its clinical significance in thoracic esophageal carcinoma ( TEC ) and to explore the theoretical basis for determining the scope of lymphadenectomy in TEC. Methods: The clinicopathologic data of 66 successive patients with solitary positive lymph nodes who underwent radical surgery on TEC were retrospectively analyzed. The exact location of the metastasized SLN was studied, and the correlation among the location of SLN, the site of primary tumor, and the depth of invasion was investigated. Univariate analyses were used to evaluate the prognostic factors in the patients. Results: In the groups we investigated, the SLN metastasis was most frequently found beside the recurrent nerve and the esophagus as well as around the stomach. There were 20 cases with skipping nodal metastasis ( 30.3% ). The SLN metastasis was limited to two or three areas in the patients with superficial TEC, and was widely distributed in those with advanced TEC, including the lymph nodes in the neck, thorax, and abdomen. The postoperative 5-year survival rates were 36.4% and 42.8 % in the group with SLN metastasis and the group without SLN metastasis, respectively, with significant differences between the two ( P < 0.05 ). The postoperative 5-year survival rates did not show any statistical difference between the group with skipping SLN metastasis ( 35.0% ) and the group without skipping metastasis ( 36.9% ). The univariate analysis showed that the depth of tumor invasion was the independent risk factor affecting the prognosis of the patients in the groups we investigated. Conclusion: The distribution of the positive SLN in TEC is closely related to the tumor location and the depth of tumor involvement. The lymph nodes beside the bilateral recurrent nerve and the paraesophageal and perigastric lymph nodes are the high-risk sites in the nodal metastases.