锁骨上淋巴结转移在食管癌外科治疗中的争议  

Supraclavicular lymph node metastasis:a controversy in the surgical treatment of esophageal cancer

作　　者：孙海波 大幸宏幸 邢文群 Sun Haibo;Daiko Hiroyuki;Xing Wenqun(Department of Thoracic Surgery,The Affiliated Cancer Hospital of Zhengzhou University(Henan Cancer Hospital),Zhengzhou 450008,China;Department of Esophageal Surgery,National Cancer Center Hospital,Tokyo103-0027,Japan)

机构地区：[1]郑州大学附属肿瘤医院(河南省肿瘤医院)胸外科,郑州450008 [2]国立癌症中心中央病院食道外科,东京103-0027

出　　处：《中华消化外科杂志》2024年第10期1295-1301,共7页Chinese Journal of Digestive Surgery

基　　金：河南省中青年卫生健康科技创新人才培养项目(YXKC2020022);河南省科技攻关重点项目(222102310170);河南省医学科技攻关省部共建重点项目(SBGJ20230202018);2023年度留学人员科技活动择优资助项目。

摘　　要：临床分期是治疗决策的重要参考,也是影响患者预后的关键因素.作为国际上重要的食管癌分期标准之一,第12版日本食管学会(JES)食管癌分期系统于2022年正式应用于临床实践.与既往JES分期系统比较,第12版JES食管癌分期系统对N分期的定义是根据淋巴结转移数目,而非肿瘤部位划分淋巴结分站.第12版JES食管癌分期系统将胸段食管癌锁骨上淋巴结转移定义为M1a期.在临床分期中,M1a期又与N2~N3期划分为同一临床分期.这提示日本学者普遍认为胸段食管癌患者发生锁骨上淋巴结转移并非手术禁忌证.结合国际抗癌联盟与美国癌症联合会联合发布的食管癌分期系统,合并锁骨上淋巴结转移的食管癌患者能否接受手术治疗仍存在较大争议.我国与日本的食管癌患者均以鳞癌为主要病理学类型,清晰地认识及解答上述问题对指导我国食管癌临床诊断与治疗具有十分重要的意义.笔者回顾相关文献,结合临床实践,探讨锁骨上淋巴结转移在食管癌治疗中的争议,旨在对食管癌转移淋巴结的准确定义以及患者的精准分期和最佳治疗模式提供参考.Clinical staging is an important reference for treatment decisions and a key factor affecting the prognosis of patients.As one of the most important international staging criteria,the 12th edition of classification of esophageal cancer of Japan Esophageal Society(JES)has been applied in clinical practice since 2022.Compared with the previous classification of esophageal cancer of JES,the N staging in 12th edition of classification of esophageal cancer is defined as the number of lymph node metastases,rather than the station of the metastatic lymph nodes according to the tumor location.It is noteworthy that the 12th edition of classification of esophageal cancer classifies supraclavicular lymph nodes as M1a stage,and M1a stage as well as N2-N3 stages are classified in the same clinical stage,which means that the Japanese scholars still believe that supraclavicular lymph node metastasis is not a contraindication to surgery for thoracic esophageal cancer.Compared with the esophageal cancer staging criteria jointly issued by the International Anti-Cancer Alliance and the American Cancer Federation,it is controversial that whether esophageal cancer patients with supraclavicular lymph node metastasis can receive surgical treatment.Since esophageal squamous cell carcinoma in China is the main pathological type as in Japan,a clear understanding and answer to the above question is of great significance in guiding the clinical diagnosis and treatment of esophageal cancer.The authors consult relevant literature and combine it with clinical practice to explore the controversy of supraclavicular lymph node metastasis in the treatment of esophageal cancer,aiming to provide reference for the accurate definition of metastatic lymph nodes in esophageal cancer,as well as the precise staging and optimal treatment mode for patients.

关 键 词：食管肿瘤 锁骨上淋巴结转移 外科治疗 综合治疗 争议 

分 类 号：R735.1[医药卫生—肿瘤]