pN0食管癌Ivor—Lewis手术后淋巴结转移性复发的危险因素  

A clinical analysis of risk factor with lymph node metastatic recurrence in patients with No esophageal cancer after Ivor-Lewis Esophagectomy

作　　者：孙志钢[1] 王洲 刘相燕[1] 刘凡英[1] 陈钢[1] 

机构地区：[1]山东大学附属省立医院胸外科,济南250021

出　　处：《中华胸心血管外科杂志》2011年第2期108-111,共4页Chinese Journal of Thoracic and Cardiovascular Surgery

摘　　要：目的 探讨pN0期食管癌病人Ivor-Lewis手术后淋巴结转移性复发的危险因素.方法 对2001年1月至2005年1月间接受Ivor-Lewis手术治疗的82例pN0期胸中段食管鳞癌病人进行前瞻性研究,用RT-PCR检测食管癌组织中淋巴管生成因子C（VEGF-C）mRNA和淋巴结组织中上皮标志物（Mucin1）mRNA的表达;Kaplan-Meier法计算复发率;Log-rank检验比较复发率;Cox回归多因素分析判定独立的危险因素.结果 42例食管癌组织中检测到VEGF-C mRNA表达;23例至少在1枚淋巴结中检测到Mucin1 mRNA表达,诊断为淋巴结微转移;手术后3年内37例发生淋巴结转移;T分期与病人3年内淋巴结转移的发生率相关（P＜0.05）;有VEGF-C mRNA表达者3年内淋巴结转移发生率显著高于无VEGF-C mRNA表达者（P＜0.01）;有淋巴结微转移者3年内淋巴结转移的发生率显著高于无淋巴结微转移者（P＜0.01）.Cox回归分析显示T分期、食管癌组织中VEGF-C mRNA表达和淋巴结微转移是病人手术后3年内淋巴结转移的独立危险因素.结论 T分期、食管癌组织中VEGF-C mRNA表达和淋巴结微转移是pN0食管癌病人Ivor-Lewis手术后淋巴结转移性复发的独立危险因素.Objective To investigate the risk factors with lymph node metastatic recurrence in patients with N0 esophageal cancer after Ivor-Lewis Esophagectomy. Methods The subjects were 82 patients with pN0 esophageal cancer who underwent Ivor-Lewis esophagectomy from January 2001 to January 2005. By using RT-PCR, VEGF-C mRNA was detected in tumor issues, and Mucin l（ MUC1 ）mRNA was detected in lymph nodes. The Kaplan-Meier method was used to calculate the survival rate and lymph nodal metastatic rate. Log-rank test was performed to compare the recurrence rate, and Cox regression multivariate analysis was performed to determine independent prognostic factors. Results VEGF-C mRNA was identified in 42 patients （51.22%）, and MUC1 mRNA was identified in 23 patients（28.05% ）from at least 1 lymph node station . The diagnosis of lymph node micrometastasis （LNMM） was based on the detection of MUC1 mRNA. The first recurrence exhibiting lymph node metastasis was recognized in 37 patients （45.1%） at the first 3 years after operation and this was significantly associated with T status （ P 〈 0. 05 ）. Lymph node metastatic rate for patients with VEGF-C mRNA expression in tumor issues was significantly higher than that for patients without VEGF-C mRNA expression（ P 〈0. 01 ）. And lymph node metastatic rate for patients with LNMM was significantly higher than that for patients without LNMM （ P 〈0. 01 ）. The results of multivariate analysis confirmed that T status, VEGF-C mRNA expression in tumor issues and LNMM were independent relevant factors. Conclusion Status,VEGF-C mRNA expression in tumor issues and LNMM in patients with N0 esophageal cancer were independent risk factors for 3-year lymph node metastatic recurrence after Ivor-Lewis Esophagectomy.

关 键 词：食管肿瘤 淋巴转移 肿瘤复发 局部 食管切除术 

分 类 号：R735.1[医药卫生—肿瘤]