T1期胸段食管鳞癌淋巴结转移规律及生存分析  

Node metastatic and prognostic analysis of superficial thoracic esophageal squamous cell carcinoma with T1 status

作　　者：王枫[1] 王健键[1] 王镇[1] 柳硕岩[1] 陈啸风[1] 林辉[1] 陈鹏[1] 

机构地区：[1]福建省肿瘤生物治疗重点实验室福建医科大学附属福建省肿瘤医院胸外科,福州350014

出　　处：《中华胸心血管外科杂志》2018年第2期71-75,共5页Chinese Journal of Thoracic and Cardiovascular Surgery

摘　　要：目的研究不同肿瘤浸润深度T1期胸段食管鳞癌淋巴结转移规律及预后价值。方法纳入1999年1月至2010年1月接受Mckeown术式、术后病理证实为T1期胸段食管鳞癌患者176例。按照日本食管癌协会分类标准，根据肿瘤浸润深度，上皮层和黏膜层（m）分为上皮层（m1）、黏膜固有层（m2）、黏膜肌层（m3），黏膜下层（Tsm）均分为黏膜下上1／3（SM1）、中1／3（SM2）、下1／3（SM3）。回顾性分析不同浸润深度淋巴结转移规律及预后价值。结果m的淋巴结转移率为4．4％，sm的淋巴结转移率为28．2％，差异有统计学意义（P=0．001），5年生存率分别为91．4％和75．8％，差异有统计学意义（P=0．048）。m1和m2无淋巴结转移，m3淋巴结转移率为6．2％；SM1、SM2和SM3淋巴结转移率分别为20％、29．4％及33．3％，差异无统计学意义，5年生存率分别为86．5％、77．4％和67．3％，差异无统计学意义。淋巴转移率最高的区域为颈部，主要集中在右颈段食管旁淋巴结（101R）。SM1、SM2及SM3颈部淋巴结转移率分别为15．0％、20．6％及24．6％，101R转移率分别为10％、8．8％及24．6％，差异均无统计学意义。单因素分析显示：淋巴结转移率与患者年龄、性别、肿瘤分化程度及肿瘤位置差异均无统计学意义，与脉管癌栓及肿瘤浸润深度（m1-3／SM1-3）差异有统计学意义。Cox多因素回归分析显示：淋巴结转移（N分期）是患者预后的独立危险因素（HR：2．127，95％CI=1．219-3．713）。淋巴结转移预后与无淋巴结转移有显著差异（P=0．005），5年生存率（无淋巴结转移／淋巴结转移：83．5％／64．7％）。结论Tsm淋巴结转移率明显高于m，SM1、SM2和SM3淋巴结转移率无明显差异。淋巴结转移（N分期）是T1期胸段食管鳞癌预后的独立危险因素。相对于胸腹部淋巴结，颈部淋巴结转移发生率更高，且集Objective To investigate the pattern of lymph node metastasis and the long-term survival in patients with su- perficial thoracic esophageal squamous cell carcinoma（ESCC） with T1 status. Methods 176 patients with pathologically con- firmed superficial ESCC with T1 status who underwent Mckeown esophagectomy between January 1999 and January 2010 were retrospectively enrolled. Tumor invasion is classified according to the Japanese Association of esophageal cancer classification standard. Epithelial layer and mucosa（m） divided into epithelial layer（ M1 ） , lamina propria mucosa（ M2 ） , muscularis muco- sa（M3） , submucosa（ M3 ）. Submucosa（Tsm） were average divided into submucous upper 1/3 （ SM1 ） , middle 1/3 （ SM2 ） and lower 1/3 （SM3）. Node metastatic pattern of different tumor invasion and the prognostic indication is investigated. Results The rate of node metastasis in patients with SM invasion is significantly higher than those with m invasion （28.2% vs. 4.4% ,P = 0. 001 ） ; the 5-year survival rate of patients with SM invasion is significantly higher than those with m invasion （91.4% vs. 75.8%, P = 0. 048）. The rate of node metastasis in patients with M1, M2, and M3 invasion is 0, 0, and 6. 2% , respectively; the rate of node metastasis in patients with SM1, SM2, and SM3 invasion is 20.0% , 29.4% , and 33. 3% , respectively, with the 5-year survival rate of 86.5% , 77.4% , and 67.3%, respectively. The highest rate of lymph node metastasis in the neck region, mainly in the right cervical paraesophageal lymph nodes（101R）. The rate of cervical lymph node metastasis in patients with SM1, SM2, and SM3 invasion is 15.0% , 20.6% and 24.6% , respectively. The rate of 101R me-tastasis in patients with SM1, SM2, and SM3 invasion is 10%, 8.8% and 24.6%, respectively. Univariate analysis showed that there is no significant difference between lymph node metastasis rate and patient age, gender, tumor differentiation and tumor location, and vaseular invasion and tumor invasio

关 键 词：食管肿瘤 淋巴结转移 生存分析 

分 类 号：R735.1[医药卫生—肿瘤]