食管癌淋巴结转移特点分析

目的:探讨食管癌淋巴结转移特点。方法:回顾性分析1 791例手术治疗的食管癌患者临床病理资料，分析淋巴结的转移规律及特点。结果:1 791例食管癌患者的淋巴结转移率为35.18%，淋巴结转移度为8.33%。基底细胞样鳞癌及腺鳞癌的淋巴结转移率及转移度与鳞癌无明显差异（均P>0.05），而腺癌及神经内分泌癌的淋巴结转移率及淋巴结转移度明显高于鳞癌（均P<0.05）。肿瘤分化、病变长度、T分期及是否有脉管癌栓是淋巴结转移率的独立影响因素（均P<0.05），并且肿瘤分化、T分期及是否有脉管癌栓是影响N分期的独立影响因素（均P<0.05）。上段食管癌的颈部淋巴结转移率要高于中、下段食管癌（P=0.002），而纵隔及腹腔淋巴结转移率在不同部位之间无显著性差异（均P>0.05）。结论:肿瘤分化、T分期及是否有脉管癌栓是影响食管癌淋巴结转移率及N分期的重要因素；上段食管癌更容易发生颈部淋巴结转移；无论肿瘤位置都应加强对腹腔淋巴结的清扫。

Characteristics of lymph node metastasis in esophageal carcinoma

Objective:To investigate the characteristics of lymph node metastasis with esophageal carcinoma.Methods:The clinicopathological characteristics of 1 791 patients with esophageal carcinoma，confirmed by surgical pathology specimens in our hospital from January 2008 to December 2013，were retrospectively analyzed.Characteristics of lymph node metastasis were studied.Results:Of the 1 791 patients，the lymph node metastasis rate was 35.18% and lymph node metastasis degree was 8.33%.The patients with adenocarcinoma and neuroendocrine carcinoma had higher lymph node metastasis rate and lymph node metastasis degree than squamous carcinoma.Multivariate analysis showed that histologic differentiation，tumor length，T stage and vascular invasion were independent risk factors for lymph node metastasis rate，and histologic differentiation，T stage and vascular invasion were independent risk factors for N stage.The cervical lymph node metastasis rate in upper esophageal carcinoma was higher than middle and lower esophageal carcinoma.No significant different of lymph node metastasis was found among upper，middle，and lower esophageal carcinoma for mediastinal and celiac lymph node.Conclusion:Histologic differentiation，T stage and vascular invasion are relating factors of lymph node metastasis rate and N stage.Cervical lymph node metastasis is more common in upper esophageal cancer.Regardless of tumor location，celiac lymph node dissection should be strengthened.