590例胸段食管鳞癌伴淋巴结转移患者三野根治术后生存分析

目的回顾性分析胸段食管鳞癌伴淋巴结转移患者在进行食管次全切除联合三野淋巴结清扫术后生存及其影响因素。方法收集1993年1月至2007年3月我院进行单纯根治性食管切除联合三野淋巴结清扫手术的胸段食管鳞癌伴淋巴结转移患者共计590例,分析术后生存及预后相关因素。结果 590例患者5年生存率为29.6%,其中N1、N2与N3期患者的5年生存率分别为41.2%、23.1%和8.9%(χ2=61.557,P=0.000)。多因素分析显示,肿瘤部位和N分期均是影响预后的独立因素。全组术后总复发转移率36.6%,血道(62.0%)、中上纵隔淋巴结(44.9%)、颈部淋巴结(35.2%)转移最为常见。结论胸段食管鳞癌伴淋巴结转移患者三野根治术后生存与肿瘤部位、N分期密切相关。颈部、中上纵隔与血道在术后复发转移概率较高。

Survival analysis of 590 cases of thoracic esophageal squamous cell carcinoma with lymph node metastasis after radical esophagectomy plus three-field lymphadenectomy

Objective To retrospectively analyze the survival and prognostic factors of patients with thoracic esophageal squamous cell carcinoma with lymph node metastasis after radical esophagectomy plus three-field lymphadenectomy. Methods A total of 590 patients underwent radical esophagectomy plus three-field lymph node dissection for node-positive thoracic esophageal squamous cell carcinoma at Fujian provincial tumor hospital between January 1993 and March 2007. Overall survival and prog- nostic factors were evaluated by univariate and multivariate analysis. Results The overall 5-year survival rate was 29.6%. The 5-year survival rates of patients with the number of lymph node metastases in pathological N1, N2 and N3 were 41.2 %, 23.1 and 8.9%, respectively （X2= 61. 557, P= 0. 000）. Univariate analysis showed that the significant prognostic factors were tumor location, pathological N staging, primary tumor length calculated by radiograph and pathological T staging. While Multi- variate analysis based on Cox proportional hazard model revealed that tumor location and pathological N staging were the inde- pendent prognostic factors. The overall rate of recurrence and metastasis was 36.6%, with the postoperative metastasis most frequent in blood （62.0%）, followed by the upper- and mid- mediastinum （44.9~） and cervical lymph node （35.2%）. Con- clusion The prognosis of patients with thoracic esophageal squamous cell carcinoma with lymph node metastasis treated with radical esophagectomy plus three-field lymphadenectomy is associated with tumor location and pathological N staging. The post- operative metastases are more frequent through blood, the upper- and mid- mediastinum and cervical lymph node.