Siewert Ⅰ型食管胃结合部腺癌淋巴结转移特点及预后分析  

Characteristics of lymph node metastasis and prognostic analysis of Siewert type I adenocarcinoma of esophagogastric junction

作　　者：亓磊[1] 田辉[1] 岳韦名[1] 李林[1] 李树海[1] 高存[1] 司立博[1] 鲁铭[1] 程传乐 

机构地区：[1]山东大学齐鲁医院胸外科,济南250012

出　　处：《中华消化外科杂志》2016年第11期1075-1080,共6页Chinese Journal of Digestive Surgery

基　　金：国家自然科学基金（81672292）

摘　　要：目的：分析SiewertⅠ型食管胃结合部腺癌（AEG）淋巴结转移特点及影响患者预后的因素。方法：采用回顾性病例对照研究方法。收集2008年1月至2011年5月山东大学齐鲁医院收治的87例行手术切除治疗Siewert Ⅰ型AEG患者的临床病理资料。患者均行经左胸后外侧切口行下段食管＋近端胃大部切除术。清扫胸腔第107、108/110、109、111、112组淋巴结和腹腔第1/2、3、4、5、6、7、10、11组淋巴结。所有淋巴结标本送常规病理学检查。观察指标：（1）肿瘤淋巴结清扫及转移情况。（2）随访及预后情况。（3）预后因素分析指标：性别、年龄、肿瘤分化程度、肿瘤浸润深度、TNM分期、淋巴结转移。（4）对独立预后因素进行分层分析。采用电话和门诊方式进行随访。术后2年内每3个月复查1次，2年后每6个月复查1次。门诊复查血生化指标、超声、钡餐、CT，必要时行胃镜检查。了解患者生存情况。随访时间截至2016年6月。计数资料以率表示，采用χ^2检验。采用KaplanMeier法绘制生存曲线并计算生存率，单因素分析采用Logrank检验，多因素分析采用COX比例风险回归模型。结果：（1）肿瘤淋巴结清扫及转移情况：87例Siewert Ⅰ型AEG患者中，15例无淋巴结转移，72例有淋巴结转移，淋巴结转移率为82.8%（72/87）。清扫的胸腔淋巴结中第107、108/110、109、111、112组淋巴结转移率分别为6.9%（6/87）、27.6%（24/87）、0、4.6%（4/87）、0，5者比较，差异有统计学意义（χ^2=63.301，P〈0.05）。清扫的腹腔淋巴结中第1/2、3、4、5、6、7、10、11组淋巴结转移率分别为52.9%（46/87）、32.2%（28/87）、10.3%（9/87）、0、0、47.1%（41/87）、0、0，8者比较，差异有统计学意义（χ^2=215.096， P〈0.05），其中第1/2组和第7组淋巴结转移率均显著高于第3组（χ^2=7.618，4.059，P〈0.05），第1/2组和第7组淋巴结转移�Objective：To analyze the characteristics of lymph node metastasis and prognostic factors of Siewert type Ⅰ adenocarcinoma of esophagogastric junction （AEG）. Methods：The retrospective casecontrol study was conducted. The clinicopathological data of 87 patients with Siewert type Ⅰ AEG who were admitted to the Qilu Hospital of Shandong University between January 2008 and May 2011 were collected. All the patients underwent lower esophageal and proximal subtotal gastrectomy via left and posterior thoracic incision. No. 107, 108/110, 109, 111, 112 thoracic lymph nodes and No.1/ 2, 3, 4, 5, 6, 7, 10, 11 abdominal lymph nodes were dissected. All the specimens of lymph nodes were detected by pathological examination. Observation indicators included： （1） lymph node dissection and metastasis, （2） followup and prognosis, （3） indexes of prognostic factors analysis： gender, age, tumor differentiation, depth of tumor invasion, TNM stage and lymph node metastasis, （4） stratified analysis of independent prognostic factors. Followup using telephone interview and outpatient examination was performed to detect the survival of patients up to June 2016. Patients were reexamined by blood biochemistry, ultrasound, barium meal, computed tomography （CT） and gastroscopy （if necessary）every 3 months within 2 years postoperatively and every 6 months after 2 years. Count data were represented as ratio and analyzed using the chisquare test. The survival curve and survival rate were respectively drawn and calculated by KaplanMeier method. The univariate and multivariate analyses were done using the Logrank test and COX regression model, respectively. Results：（1） Lymph node dissection and metastasis： of the 87 patients with Siewert type Ⅰ AEG, 15 didn′t have lymph node metastasis and 72 had lymph node metastasis, with a metastasis rate of 82.8% （72/87）. Metastasis rates of No.107, 108/110, 109, 111 and 112 thoracic lymph nodes were respectively 6.9%（6/87）, 27.6% （24/87）, 0, 4.6% �

关 键 词：食管胃结合部肿瘤 腺癌 Siewert Ⅰ型 淋巴结转移 预后 

分 类 号：R735[医药卫生—肿瘤]