胸段食管鳞癌淋巴结转移强度和淋巴结清扫手术方式分析

背景与目的:淋巴结转移强度包括淋巴结转移数量和淋巴结转移度。淋巴结转移度即术后病理证实的淋巴结转移数和切除淋巴结数的比值。这两个指标是评估食管癌分期和预后的重要指标。本研究探讨胸段食管鳞癌淋巴结转移强度以及影响淋巴结转移强度的因素,进而探讨淋巴结清扫术式。方法:在中山大学附属第二医院手术切除的120例食管鳞癌患者,术中按美国胸科协会(AST)Casson修订淋巴结分组清扫淋巴结。结果:120例胸段食管鳞癌清扫淋巴结2631个,平均每例22个。胸上段食管鳞癌向颈部转移的淋巴结转移度(20.9%)大于胸中段(12.9%)和胸下段食管癌(6.8%)(P<0.05)。胸下段淋巴结向腹部胃周转移淋巴结转移度(37.5%)大于胸中段(17.5%)和胸上段食管癌(7.1%)(P<0.05)。隆突淋巴结转移以中段多见。食管癌浸润深度、食管癌分化、食管环壁生长程度与淋巴结转移强度显著相关(P<0.05),食管癌病变长度与转移强度不相关(P>0.05)。经右胸三野淋巴结清扫术后生存时间优于经左胸二野淋巴结清扫术(P<0.05)。结论:食管癌术中应注意淋巴结转移强度高的区域淋巴结清扫。食管癌浸润深度、食管癌分化、食管环壁生长程度是影响淋巴结转移强度的重要因素。在胸段食管癌淋巴清扫手术中,经右胸三野淋巴结清扫明显优于经左胸二野淋巴结清扫术。

Lymphatic metastasis intensity of and lymphadenectomy for thoracic esophageal squamous cell carcinoma

BACKGROUND & OBJECTIVE: The intensity of lymphatic metastasis consists of lymph node metastasis number (LMN) and lymph node metastasis ratio (LMR). LMR is the ratio of positive nodes to dissected nodes. LMN and LMR are 2 important prognostic factors of esophageal cancer, and are adopted in tumor staging. This study was to assess the lymphatic metastasis intensity of thoracic esophageal squamous cell carcinoma (ESCC), and explore the influential factors and lymphadenectomy pattern. METHODS: A total of 120 patients with ESCC had been operated in the Second Affiliated Hospital of Sun Yat-sen University from 1998 to 2000. The lymph nodes were dissected according to the mapping scheme of the American Thoracic Society (ATS) modified by Casson et al. RESULTS: A total of 2 631 lymph nodes were dissected with an average of 22 lymph nodes in each case. The cervical LMR was significantly higher in the upper thoracic ESCC than in the middle and lower thoracic ESCC (20.9% vs. 12.9% and 6.8%, P<0.05). The left gastric LMR was significantly higher in the lower thoracic ESCC than in the middle and upper thoracic ESCC (37.5% vs. 17.5% and 7.1%, P<0.05). Subcarinal metastatic lymph nodes were often found in the middle thoracic ESCC. T stage, histological differentiation, and circum wall involvement degree were correlated to lymphatic metastasis intensity (P<0.05); the length of esophageal lesion had no correlation to lymphatic metastasis intensity (P>0.05). The survival time of the patients received the right thoracic esophagectomy with 3-field lymphadenectomy (3-FL) was significantly longer than that of the patients received the left thoracic esophagectomy with 2-FL (P<0.05). CONCLUSIONS: During the operation on ESCC, the regions with high lymphatic metastasis intensity should be dissected. T stage, histological differentiation, and circum wall involvement degree are important influential factors of lymphatic metastasis intensity. The right thoracic esophagectomy with 3-FL is superior to the left thoracic esophagectomy with 2-FL.