SiewertⅡ型和Ⅲ型局部晚期胃食管交界处腺癌根治术后淋巴结复发规律分析  

Pattern of nodal recurrence after curative resection in Siewert Ⅱ and Ⅲ locally advanced adenocarcinoma of gastroesophageal junction

作　　者：张佳佳[1] 梁振威[2] 李颖[2] 王鑫[1] 唐源[1] 刘童瞳 冯燕茹[1] 李宁[1] 余静[1] 李帅[1] 任骅[1] 邹霜梅[3] 姜军[2] 韩伟[1] 王维虎[1] 王淑莲[1] 宋永文[1] 刘跃平[1] 房辉[1] 刘新帆[1] 余子豪[1] 李晔雄[1] 蒋力明[2] 金晶[1] 

机构地区：[1]中国医学科学院肿瘤医院放疗科,北京协和医学院100021 [2]中国医学科学院肿瘤医院影像诊断科,北京协和医学院100021 [3]中国医学科学院肿瘤医院病理科,北京协和医学院100021

出　　处：《中华放射肿瘤学杂志》2016年第4期356-361,共6页Chinese Journal of Radiation Oncology

摘　　要：目的：探讨胃食管交界处腺癌根治术后淋巴结复发规律，为高危淋巴引流区照射范围的设计提供依据。方法回顾分析本院2009—2013年初治、病例资料完善的局部晚期胃食管交界处腺癌患者78例，纳入条件为接受根治性手术；病理证实为T3、T4期或淋巴结转移阳性胃食管交界处腺癌；结合内镜、上消化道造影、术中所见及病理大体标本记录，明确为SiewertⅡ、Ⅲ型；未行术前或术后放疗；影像学诊断为术后淋巴结复发，具有可调阅的CT图像并可清楚、完整显示复发位置。结果中位复发时间为10个月（1～48个月），90％复发为术后2年内。复发最高危部位为第16b1组（39％）、16a2组（37％）、9组（30％）和11p组（26％）淋巴结。 SiewertⅡ、Ⅲ型在各淋巴引流区的复发率相近（ P＝0．090～1．000）。 N3期患者最多见（＞15％）复发部位为第16b1、16a2、9、16b2、11p、7组淋巴结，非N3期患者最多见（＞15％）复发部位为第11p、16b1、16a2、9、8、7组淋巴结；两者腹主动脉旁（第16a2－b2组）复发率更高（67％∶33％，P＝0．004；OR＝4．00，95％ CI为1．54～10．37）。结论腹腔干、脾动脉近端及腹膜后（16a2、16b1区）是SiewertⅡ、Ⅲ型局部晚期胃食管交界处腺癌患者淋巴结复发最高危区域，且N3期患者具有更高的腹膜后复发风险，术后放疗靶区设计应考虑涵盖上述部位。Objective To investigate the pattern of nodal recurrence after curative resection in adenocarcinoma of the gastroesophageal junction （ AGE ） , and to provide a basis for delineation of the radiation range in the high-risk lymphatic drainage area.Methods A retrospective analysis was performed in 78 patients with locally advanced AGE who were newly treated in our hospital from January 2009 to December 2013 and had complete clinical data.All patients received curative resection and were pathologically diagnosed with stage T3/T4 or N （＋） AGE.Those patients were also diagnosed with SiewertⅡor Ⅲ AGE by endoscopy, upper gastroenterography, macroscopic examination during operation, and pathological specimens.None of the patients received preoperative or postoperative radiotherapy.All patients were diagnosed by imaging with postoperative nodal recurrence.The computed tomography images of those patients were accessible and had all the recurrence sites clearly and fully displayed.Results The median time to recurrence was 10 months （ 1-48 months） , and 90%of the recurrence occurred within 2 years after surgery.The lymph nodes with the highest risk of recurrence were No.16b1（ 39%） , No.16a2（ 37%） , No.9 （30%）, and No.11p （26%）, respectively.There was no significant difference in the recurrence rate within each lymphatic drainage area between patients with SiewertⅡandⅢAGE （ P=0.090-1.000） .The lymph nodes with the most frequent recurrence were No.16b1, No.16a2, No.9, No.16b2, No.11p, and No.7 in patients with stage N3 AGE and No.11p, No.16b1, No.16a2, No.9, No.8, and No.7 in patients with stage non-N3 AGE.Patients with stage N3 AGE had a significantly higher recurrence rate in the para-aortic regions （No.16a2-b2） than those with stage non-N3 AGE （67%vs.33%, P=0.004, OR=4.00, 95% CI=1.54-10.37） .Conclusions The lymph nodes with the highest risk of recurrence are located in the celiac artery, proximal splenic artery, and retroperitoneal areas （ No.16a2 and No.16b1） in patien

关 键 词：腺癌 胃食管交界处/外科学 淋巴结复发 靶区勾画 

分 类 号：R735[医药卫生—肿瘤]