322例食管、贲门癌淋巴结转移资料分析

目的探讨不同期别、不同部位食管、贲门癌淋巴结转移规律。方法回顾2002年1月至2006年12月间单纯手术治疗、资料完整的322例食管、贲门癌病人资料。根据UICC(1997)食管癌分期标准,对术中所见、术后病理切取检验的淋巴结数目统计,计算出不同期别、不同部位食管、贲门癌淋巴结转移率、转移度。结果T1、T2N1M0(IIB期)食管、贲门癌淋巴结转移率为30%。其中食管癌淋巴结转移率为31.82%,贲门癌为16.67%;T3N1M0、T4任何NM0(III期)食管、贲门癌淋巴结转移率为87.5%。其中食管癌淋巴结转移率为92.3%,贲门癌为81.82%。同一肿瘤浸润深度、不同长度的淋巴结转移率无差别。病变在3cm以内,各浸润度的淋巴结转移率差别不大。但大于3cm以上淋巴结转移率明显升高(P<0.05)。高分化食管癌淋巴结转移率为33.33%,低分化食管癌淋巴结转移率为71.43%(P<0.01);高分化贲门癌淋巴结转移率为20%,低分化贲门癌淋巴结转移率为85.37%(P<0.001)。结论食管癌和贲门癌淋巴结转移有各自的规律,贲门癌应当作为一个独立的疾病进行研究。肿瘤的长度不是影响淋巴结转移的重要因素,肿瘤的分化程度和浸润深度与淋巴结转移密切相关。

The analysis of 322 cases of lymph node metastases with esophageal-cardiac carcinoma

Objective To explore the rules of lymph node metastasis of the esophageal-cardiac carcinomas in distinct stage and different location.Methods To review the data of 322 cases suffered esophageal-cardiac carcinoma that all had been operated.According to the UICC staging stardards(1997)of esophageal cancer.Counting the numbers of lymph nodes meted with operation and examined by pathology.The lymph node metastatic rates(LNMR)and degree of lymph node metastasis in distinct location and different stage were counted.Results The LNMR of esophageal-cardiac carcinoma on T1,T2N1M0(stage ⅡB)was 30% which esophageal cancer was 31.82% and cardiac carcinoma was 16.6%;T3N1M0,T4 any NM0(stage Ⅲ)was 87.5% which esophageal cancer was 92.3%.Cardiac carcinoma was 81.82%.There was no difference in the LNMR among the same depth and different length.The LNMR which lengths were within 3 cm but different depths was no different.The LNMR beyond 3 cm of tumor was obvious raise(P<0.05).The LNMR of mature esophageal cancer was 33.33% and immature was 71.43%(P<0.01).The LNMR of mature cardiac carcinoma was 20% and infantile was 85.37%(P<0.001).Conclusion There are different rules in the lymph node metastases of esophageal cancer and cardiac carcinoma.The cardiac carcinoma should research as a independent disease.The length of cancer is not important factor in lymph node metastasis but the depth and degree of carcinoma differentiation obviously effect the lymph node metastasis.