T1a与T1b期食管鳞癌淋巴结转移风险因素的差异  

Differences in risk factors of lymph node metastasis between stage T1a and T1b esophageal squamous cell carcinoma

作　　者：诸葛灵敦 王胜飞 谢俊涛 黄彬豪 张磊 相加庆 张亚伟[1,2] 陈苏峰 陈严严[4] LUKETICH James 陈海泉[1,2] 张杰[1,2] ZHUGE Lingdun1,2, WANG Shengfei1,2, XlE Juntao1,2, HUANG Binhao1,2 ZHANG Lei2, 3, XlANG Jiaqing1,2, ZHANG Yawei1,2, CHEN Sufeng1,2, CHEN Yanyan4, LUKETICH James5, CHEN Haiquan1,2, ZHANG Jie1,2(1. Department of Thoracic Surgery, Fudan University Shanghai Cancer Center, Shanghai 200032, China; 2. Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China; 3. Department of Pathology, Fudan University Shanghai Cancer Center, Shanghai 200032, China; 4. Department of Respiratory Medicine, Huadong Hospital, Fudan University, Shanghai 200040, China; 5. Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, Pittsburgh 15213, US)

机构地区：[1]复旦大学附属肿瘤医院胸外科,上海200032 [2]复旦大学上海医学院肿瘤学系,上海200032 [3]复旦大学附属肿瘤医院病理科,上海200032 [4]复旦大学附属华东医院呼吸内科,上海200040 [5]美国匹兹堡大学医学中心胸心外科,匹兹堡15213

出　　处：《肿瘤》2018年第10期951-957,共7页Tumor

基　　金：上海市科学技术委员会科研计划项目(编号:15411951602,16401970704);上海市基础研究重点项目(编号:14JC1401400)

摘　　要：目的 :探讨淋巴结转移危险因素(尤其是病灶大小)在T1a与T1b期食管鳞癌患者中的差异和共性,并进一步细化早期食管癌患者接受内镜下根治性治疗的适应症。方法 :回顾整理2010年1月—2016年12月在复旦大学附属肿瘤医院接受食管癌根治术且术后病理诊断为T1期的食管鳞癌患者资料,结合病灶浸润深度、分化程度、脉管侵犯、病灶长度及随访结果,应用单因素和多因素Logistic回归分析对比T1a和T1b期食管鳞癌患者发生淋巴结转移的独立危险因素及其差异。结果 :共纳入T1期食管鳞癌患者543例。对比T1a和T1b期患者的淋巴结转移风险因素,主要差异有:低分化和病灶> 2 cm在T1a期中无预测价值(P=0.832,P=0.133),而在T1b期可作为独立预测因子(P=0.002,P=0.032);脉管内癌栓在T1a和T1b期患者中均为淋巴结转移的独立预测因子(P=0.007和P <0.001)。对T1a期且病灶> 2 cm的食管鳞癌患者进行生存分析,结果显示行单纯内镜下R0切除术与行食管癌根治术的患者预后无明显差异(P=0.140)。另外,对T1a期肿瘤浸润深度进行划分,浸润至黏膜肌层(Tm3)是T1a期食管鳞癌患者发生淋巴结转移的高危因素(P=0.031)。结论 :对于行内镜R0切除术后的T1a与T1b期食管鳞癌患者,其淋巴结转移的高危因素存在明显差异,临床上应区别对待。Objective： To investigate the differences and similarities of the risk factors（especially lesion size） of lymph node metastasis（LNM） between stage T1a and T1b esophageal squamous cell carcinoma （ESCC）, and to further refine the indications of endoscopic radical treatment for early stage esophageal carcinoma.Methods： Retrospective analysis was performed for the patients who received esophagectomy were diagnosed with T1-stage ESCC pathologically in Fudan University Shanghai Cancer Center from January 2010 to December 2016. The clinicopathological characteristics including tumor invasion depth, tumor differentiation degree, tumor size and lymphovascular invasion, as well as followup data were collected. Univariate analysis and multivariate Logistic regression analysis were performed to determine the differences in independent risk factors of LNM between T1a and T1b ESCC.Results： Total of 543 patients with T1-stage ESCC were included. Poor differentiation and tumor length larger than 2 cm were independent predictors for LNM in T1b-stage patients（P = 0.002, P = 0.032）, but the ones were not related to LNM in T1a-stage patients（P = 0.832, P = 0.133）. Lymphovascular invasion was an independent predictor for both T1a-and T1b-stage patients（P = 0.007, P 〈0.001）, respectively. Survival analysis showed no significant differences in relapse-free survival（RFS） between endoscopic R0 resection and esophagectomy for T1a-stage ESCC patients with tumor length 〉2 cm（P = 0.140）. In T1a-stage ESCC, the tumor invasion of lamina muscularis mucosa（Tm3） was an independent risk factor of LNM（P = 0.031）.Conclusion： The risk factors of LNM are different in stage T1a and T1b ESCC patients after endoscopic R0 resection, and which should be treated wisely.

关 键 词：食管肿瘤 淋巴转移 淋巴结切除术 危险性评估 

分 类 号：R735.1[医药卫生—肿瘤]