胸段食管癌单纯放疗后淋巴结转移规律探讨

目的探讨胸段食管癌单纯放疗后淋巴结转移规律及其影响因素。方法对未行手术治疗单纯放疗的胸段食管癌患者338例进行研究,分析食管癌不同病变部位淋巴结转移率以及肿瘤浸润深度、病变长度、肿瘤分化程度、不同放疗技术等因素对淋巴结转移的影响。结果 （1）133例食管癌发生淋巴结转移,淋巴结转移率39.3%。（2）胸上段、胸中段、胸下段食管癌淋巴结转移率分别为37.0%3、6.1%、47.7%。胸上段食管癌颈部、上纵隔、中纵隔、下纵隔和腹腔淋巴结转移率分别为25.0%、42.5%、20.0%、7.5%和5.0%;胸中段食管癌分别为19.2%、32.7%2、1.2%、9.6%和17.3%;胸下段食管癌分别为17.1%、14.6%2、2.0%、12.2%和34.1%。（3）食管壁CT下形态≤5 mm与〉5 mm脂肪线完整、脂肪线消失、外侵征象的淋巴结转移率分别为25.0%与39.2%、42.2%、34.5%。组间比较差异无统计学意义。（4）病变长度≤3 cm组、3～5 cm组和〉5 cm组淋巴结转移率分别为34.7%、38%和47.6%,组间比较差异均无统计学意义。（5）中高分化、低分化癌淋巴结转移率为36.9%和76.2%（P〈0.01）。（6）普通放疗、三维适形放疗的淋巴结转移率为41.7%、37.4%,组间比较差异无统计学意义。结论胸段食管癌易发生淋巴结转移,且发生时间早,涉及部位多。低分化癌尤其明显。胸上段易于发生颈部及上纵隔淋巴结转移;胸中段既可向上也可向下转移;胸下段以腹部转移多见,各段下纵隔淋巴结转移均较少见。

Analysis on the pattern of lymphatic metastasis after radiotherapy for esophageal carcinoma

Objective To explore the pattern of lymphatic metastasis and influencing factors of esophageal carcinoma.Methods We reviewed the pathological specimens from 338 esophageal carcinoma patients who underwent radiotherapy.We analyzed the lymph node metastasis pattern of the primary tumor in different locations and the corresponding influencing factors such as pathological T stage,tumor length,pathological morphology and tumor differentiation.Results（1） Lymph node metastasis rates were 39.3%（133/338）.（2） Lymphatic metastasis rate in the superior mediastinum,the middle mediastinum,and the inferior mediastinum cancer were 37.0%,36.1%,,and 47.7%,respectively;For patients with upper thoracic esophageal carcinomas,lymphatic metastasis rates in the neck,the superior mediastinum,the middle mediastinum,the inferior mediastinum and the abdominal cavity were 25.0%,42.5%,20%,7.5% and 5.0%,respectively.For patients with middle thoracic esophageal carcinomas,the rates were 19.2%,32.7%,21.2%,9.6% and 17.3%,respectively.For patients with lower thoracic esophageal carcinomas,the rates were 17.1%,14.6%,22.0%,12% and 34.1%,respectively.（3） Lymphatic metastasis rate in ≤5mm、5mm with fat gap whole,fat gap disappear and invasion in CT scans cancer were 25.0%,39.2%,42.2%,and 34.5%,respectively,with no statistical significance.（4） Lymphatic metastasis rate in patients with tumor≤3cm,3 to 5cm,and 5cm were 34.7% and 38%,and 47.6%,respectively,with no statistical significance.（5） Lymphatic metastasis ratios of the pathological morphology in well-differentiated and Poorly differentiated carcinoma types were 36.9%,76.2%,respectively（P0.01）.（6） Lymphatic metastasis rate in patients who underwent routine radiotherapy and 3D-CRT were 41.7% and 37.4%,respectively.Conclusion Lymphatic metastasis of esophageal carcinoma metastasizes widely even if in early T stage.Pathological morphology and tumor differentiation are relating factors of lymph node metastasis of thoracic sophageal carcinoma.The incidences of lymphatic metastasis in upper thoracic,middle thoracic and lower thoracic were high,but the incidence of mediastinal lymph nodes metastasis in each inferior mediastinum was low.