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。

Investigation of influence factors for subcarinal lymph node metastasis of thoracic esophageal carcinoma

Objective To investigate the metastasis rule of subcarinal lymph nodes of thoracic esophageal carcinoma and the related influence factors.Methods Retrospectively analyzed the clinical data of 1402 patients that underwent the radical surgery for esophageal carcinoma in Anyang Cancer Hospital,from June 2015 to May 2018(the Lymph node dissection includes subprotuberant lymph nodes).Results The incidence of subcarinal metastasis of thoracic esophageal cancer was 8.35%,and the incidence of subcarinal metastasis of thoracic esophageal cancer was no correlation between the patient's gender,age,pathological type and surgical method(P>0.05).The incidence of subcarinal metastasis of thoracic esophageal carcinoma is related to tumor site,depth of invasion,degree of lymph node metastasis,degree of differentiation,TNM stage,vascular cancer embolus,nerve invasion and preoperative treatment(P<0.05).Conclusion The incidence of subcarinal lymph node metastasis of thoracic esophageal cancer is higher,but the incidence of subcarinal lymph node metastasis of esophageal cancer of upper thoracic cancer and esophageal cancer of stage cT1 is lower,and selective dissection is feasible.Middle and lower thoracic esophageal carcinoma should still be treated as lymph node dissection site.Patients with subcarinal lymph node metastasis significantly decreased after preoperative radiotherapy or preoperative concurrent chemoradiotherapy.Preoperative radiotherapy or preoperative concurrent chemoradiotherapy is recommended for local advanced esophageal cancer.