病理N1期食管鳞状细胞癌患者淋巴结转移规律及其危险因素  

Characteristics and risk factors of lymph node metastasis in pN1 stage esophageal squamous cell carcinoma

作　　者：马钊[1] 陈传贵[1] 段晓峰[1] 刘肖琼 弓磊[1] 于振涛[1] 

机构地区：[1]天津医科大学肿瘤医院食管肿瘤科国家肿瘤临床医学研究中心天津市肿瘤防治重点实验室,300060

出　　处：《中华外科杂志》2015年第7期513-517,共5页Chinese Journal of Surgery

摘　　要：目的 探讨病理N1期食管鳞状细胞癌淋巴结转移规律及其危险因素.方法 回顾性分析2005年1月至2008年12月天津医科大学肿瘤医院食管肿瘤科181例接受食管癌切除术的病理N1期患者的临床资料.患者男性154例,女性27例;年龄38 ～ 84岁.手术采用左胸入路69例,右胸入路112例,均行系统性淋巴结清扫.应用χ^2检验和Logistic回归对各部位淋巴结转移与临床因素的相关性进行单因素和多因素分析.结果 早期淋巴结转移率较高部位为中下食管旁（38.4％）、贲门周围（35.3％）和胃左动脉旁淋巴结（38.8％）.单因素分析结果显示,中下食管旁淋巴结转移只与浸润深度有关（χ^2=11.754,P=0.009）.上纵隔淋巴结转移与肿瘤部位有关（P=0.039）.中下纵隔淋巴结转移与浸润深度（χ^2=8.694,P=0.034）和TNM分期（χ^2=6.906,P=0.032）有关.腹部淋巴结转移与肿瘤部位、肿瘤最大径、浸润深度和TNM分期均有关（χ^2 =5.713～16.749,P＜0.05）.多因素分析结果显示,肿瘤部位为腹部淋巴结转移的独立危险因素.结论 病理N1期食管鳞状细胞癌患者的淋巴结转移率与肿瘤部位、浸润深度、肿瘤最大径和TNM分期有关.术中应对淋巴结转移高发部位进行重点清扫.Objective To analyze the pattern and the clinicopathologic risk factors of lymph node metastasis （LNM） in pN1 stage esophageal squamous cell carcinoma.Methods Clinical data of 181 patients （154 male and 27 female patients,aging from 38 to 84 years） who underwent esophagectomy during January 2005 and December 2008 were reviewed,including 69 cases through left thoracotomy and 1 12 cases through right thoracotomy.All patients underwent systematic lymphadenectomy.The risk factors related to lymph node metastasis were analyzed by χ^2 test and Logistic regression analysis.Results The relatively highest LNM site were middle and lower thoracic paraesophageal （38.4%）,right and left cardiac （35.3%） and the left gastric artery （38.8%）.The LNM of middle and lower thoracic paraesophageal was correlated with T stage （χ^2 =11.754,P =0.009）.A correlation was also found among the LNM of upper mediastinum and the location of tumor （P =0.039）.The T stage （χ^2 =8.694,P =0.034） and TNM stage （χ^2 =6.906,P =0.032） were the risk factors of the LNM of middle and lower mediastinum.The risk factors of the LNM of abdomen were the location of tumor,the length of tumor,T stage and TNM stage （χ^2 =5.713 to 16.749,P 〉 0.05）.Multivariate analysis showed that the location of tumor is the independent risk factors for the abdominal lymph node metastasis.Conclusions The relatively highest LNM sites are correlated with the location of tumor,T stage,the length of tumor and TNM stage.According to the risk factors of LNM,the relatively highest LNM sites should be mainly swept.

关 键 词：食管肿瘤 淋巴结转移 癌 鳞状细胞 淋巴结清扫 

分 类 号：R735.1[医药卫生—肿瘤]