胸段食管癌胸廓入口处淋巴结的转移特点

目的:了解胸段食管癌胸廓入口处淋巴结的转移特点,探讨合理的上纵隔淋巴结的清扫范围.方法:回顾性分析2004年11月至2010年6月150例接受胸段食管癌三切口根治术患者的临床及病理资料.结果:全组淋巴结转移率为60.7%,其中胸廓入口处淋巴结转移率为32.7%,转移度为20.99%.单因素分析显示:胸上、中、下段食管癌均可向胸廓入口处淋巴结转移,其转移率分别为57.7%、28.9%、23.5%;不同分段之间胸廓入口处淋巴结转移率具有统计学意义(χ2=9.020、P=0.010).高、中、低分化食管癌胸廓入口处淋巴结的转移率分别为13.0%、40.9%、43.8%;不同组织分化程度的食管癌胸廓入口处淋巴结的转移率有统计学差异(χ2=11.665,P=0.003).肿瘤浸润深度、肿瘤直径与胸廓入口处淋巴结转移比较差异无统计学意义.多因素分析显示:组织分化程度和病变部位是影响胸廓入口淋巴结转移的危险因素.结论:胸廓入口处淋巴结的清扫对预防胸段食管癌术后局部复发和转移有重要意义.

Characterization of Lymph Node Metastasis at the Thoracic Inlet in Thoracic Esophageal Carcinoma

To understand the characteristics of lymph node metastasis at the thoracic inlet in thoracic esophageal carcinoma ( TEC ), and to investigate the reasonable clearing range of upper mediastinal lymph nodes. Methods: Clinical and pathological data of 150 patients who underwent three-incision radical surgery for TEC in our hospital from November 2004 to June 2010 were analyzed. Results: The incidence of lymph node metastasis among all patients was 60.7% in which the nodal metastasis at the thoracic inlet was 32.7%, and the degree of metastasis was 20.99%. Univariate analysis showed that the TEC at the upper, middle, and inferior segments could metastasize to the lymph nodes of the thoracic inlet; the rates of nodal metastasis at the inlet of thorax of each segments, that is, the upper, middle, and inferior segment, were 57.7%, 28.9%, and 23.5% ( χ2 = 9.02, P = 0.01 ), respectively. There were statistical differences in the lymph-node metastasis at the inlet of thorax among different segments. The lymph-node metastases with different degrees of differentiation, specifically, the well, moderately, and poorly differentiated cells, were 13%, 40.9%, and 43.8%, respectively. Statistically significant differences were observed among the metastatic rates of lymph nodes at the thoracic inlet with different degrees of differentiation ( χ2 = 11.67, P = 0.003 ). There were no statistical differences among the depth of the tumor infiltration, the tumor size, and the rate of lymph node metastasis at the thoracic inlet. Multivariate analysis indicated that the histologic differentiation of the tumors and the diseased regions were the risk factors that affect lymph node metastasis at the thoracic inlet. Conclusion: Lymph node dissection at the thoracic inlet plays an important role in preventing the regional recurrence and metastasis of TEC after surgery.