胸段食管鳞癌术后复发模式及淋巴结复发规律  

Postoperative recurrent pattern and the lymph node metastatic stations of the thoracic esophageal squamous cell carcinoma

作　　者：李春阳 余静 沈九零 欧阳雯[1] 徐禹[1] 张俊红[1] 谢丛华[1] Li Chunyang;Yu Jing;Shen Jiuling;Ouyang Wen;Xu Yu;Zhang Junhong;Xie Conghua(Department of Radiation and Medical Oncology, Zhongnan Hospital of Wuhan University, Wuhan 430071, China)

机构地区：[1]武汉大学中南医院放化疗科,430071

出　　处：《中华放射肿瘤学杂志》2019年第9期673-676,共4页Chinese Journal of Radiation Oncology

基　　金：武汉大学中南医院科技创新培育基金(2016050、2017049).

摘　　要：目的探索胸段食管鳞癌术后复发模式,为指导术后放疗靶区提供依据。方法回顾分析武汉大学中南医院2011-2017年间接受根治性切除且术后复发的66例胸段食管鳞癌患者临床资料,参照AJCC第八版食管癌分期定义,将1-8M区定义为中上纵隔淋巴结引流区,8Lo、9、15区定义为下纵隔淋巴结引流区,16-20区定义为上腹部淋巴结引流区。结果41例(62%)患者发生单纯局部区域复发,25例(38%)为远处转移。54例患者共计148枚淋巴结发生治疗失败,最高危的复发区域为中上纵隔淋巴结引流区(118/148,80%),其次为上腹部淋巴结引流区(24/148,17%)。发生上腹部淋巴结失败患者共计9例,其中6例为胸下段癌,8例(89%)为术后病理≥Ⅲ期。结论胸段食管鳞癌术后复发高危淋巴结区为中上纵隔,术后放疗靶区应重点涵盖。对于术后病理≥Ⅲ期胸下段鳞癌患者需谨慎考虑照射上腹部淋巴结引流区。吻合口及下纵隔可能不需常规包含在射野内.Objective To investigate postoperative recurrent pattern of the thoracic esophageal squamous cell carcinoma (TESCC), aiming to provide a basis for the delineation of postoperative radiotherapy volume for TESCC. Methods Clinical data of 66 TESCC patients who recurred after the radical esophagectomy in Zhongnan Hospital of Wuhan University from 2011 to 2017 were retrospectively analyzed. According to the AJCC 8th edition-defined classification of esophageal carcinoma, regional lymph node stations 1 to 8M were defined as the upper-middle mediastinum region (UMMR), and stations 8Lo, 9 and 15 were defined as the inferior mediastinum region (IMR), stations 16 to 20 were regarded as the upper abdominal lymph node region (UAR). Results Among all 66 patients, 41 cases (62%) experienced loco-regional recurrence alone, 25 cases (38%) presented with distant metastasis alone. A total of 54 patients with 148 lymph node recurred after treatment. The highest risk region of lymph node recurrence was UMMR (118/148, 80%), after that, followed by UAR (24/148, 17%). With regard to 9 cases of UAR, 6 patients had lower TESCC, and 8 patients (89%) were graded as ≥ pathological stage Ⅲ. Conclusions The highest risk region of lymph node recurrence is UMMR in TESCC patients undergoing radical esophagectomy, which should be considered as the target volume in postoperative radiotherapy. For patients with lower TESCC ≥ pathological stage Ⅲ, UAR might be the target volume with cautions. Anastomosis and IMR are probably not the routine treatment volumes.

关 键 词：食管肿瘤 复发模式 淋巴结复发高危区域 放疗靶区 

分 类 号：R735.1[医药卫生—肿瘤]