淋巴结转移对胸段食管癌及食管胃交界部癌预后的影响

目的：分析胸段食管癌和食管胃交界部癌不同淋巴结转移状况及清扫范围对预后的影响。方法：随访资料完整的906例胸段食管癌及食管胃交界部癌患者，分析淋巴结转移及清扫范围对其预后的影响。结果：食管癌组：阳性淋巴结个数在0、1—3、〉3个三个级别的预后差异显著（P〈0．01）；淋巴结转移度在0、〉0-20％、〉20％三个级别的3年、5年生存率差异显著（P=0．000）；淋巴结胸腹部联合清扫、单纯胸部清扫、单纯腹部清扫的生存曲线无显著差异（P〉0．05）；隆突下淋巴结阴性的N1M0期、T2N1M0期、T3N1M0期胸段食管癌预后明显优于阳性组（P〈0．01）。食管胃交界部癌组：N0期病例预后优于N1、N2、N3期病例（P〈0．05）；淋巴结转移度在0、〉0—50％、〉50％三个级别的生存曲线预后差异显著（P〈0．05）；胸腹部联合淋巴结清扫、单纯胸部清扫、单纯腹部清扫的生存曲线无显著差异（P〉0．05）。结论：淋巴结转移数量、转移度、转移范围均是影响食管癌预后的重要因素。隆突下淋巴结转移影响食管癌的预后，应重视该区的清扫。淋巴结转移度是食管胃交界部癌预后的重要指标。食管癌、食管胃交界部癌淋巴结清扫不同范围的各组生存曲线无显著差异。

Carcinoma of the thoracic esophagus and esophagogastric junction.lymph node metas- tasis and its impact on prognosis

Objective： The impact to prognosis of lymph node metastasis and dissection on the carcinoma of esoph- agus （EC） and esophagogastric junction （EJC） were studied. Methods： The clinical findings of 906 patients with car- cinoma of esophagus（575） and esophagogastric junction （331） underwent radical surgery with complete follow - up and pathological data were divided into two groups ： EC and EJC group. The impact to prognosis of the patients related to the lymph node metastasis and dissection were analyzed respectively. Results：There was a significant difference be- tween the prognosis of the patients with the number of positive lymph node in 0,1 - 3 and 〉 3. Also the 3 - year and 5 - year survival rates were significantly different among grade of the lymph node metastasis in EC group. The survival curves were similar in the patients underwent lymph node dissection trans - abdominal - thoracic, transthoracic or transabdominal only both in EC and EJC group. Otherwise the prognosis of patients in N1M0,T2NIM0 and T3NIMo with negative subcarinal lymph nodes was significantly superior to those with positive subcarinal lymph nodes. The prognosis of patients with No was significantly superior to those with N1 , N2 and N3 in EJC group. There was significant difference in survival curves among 0 LNM degree, 〉0 -50% LNM degree and 〉 50% LNM degree respectively（P 〈 0.05 ）. There was no significanct difference in survival curves among collo - thoraco - abdominal dissection group, thoracic dissection group and abdominal dissection group（P 〉 0.05 ）. Conclusion：The number, degree and extent of positive lymph nodes that particularly in the subcarinal region are important factors to prognosis of patients with EC, but the survival curve was similar in the different fields of lymph node dissection both in the EC and EJC group. Fur- thermore, it seemed that the LNM degree could be an important indicator to predict the prognosis of patients with EJC.