食管癌淋巴结转移对手术治疗预后的影响

The prognostic significance of lymph node metastasisin surgical resection of esophageal cancer

作者对４７４例未经放疗的食管癌切除病例进行回顾性分析，从淋巴结转移率及转移度评价对预后的影响。全组有淋巴结转移者２１１例，转移率为４４．５％（２１１／４７４）；术中摘除并经过病理学检查的淋巴结总数为５３８０枚，其中６９０枚有癌转移，转移度为１２．８％（６９０／５３８０）。本组总五年生存率为３０．６％（１４５／４７４）；有淋巴结转移者为１２．８％（２７／２１１），无淋巴结转移者为４４．９％（１１８／２６３）。作者认为：术时根治性切除淋巴结是肿瘤外科的重要组成部分，这在肿瘤尚处于局限范围内时尤为重要。但在晚期病例肿瘤已有较广泛扩散的情况下，按常规扩大清扫淋巴结的意义不大。

AbstractThe metastatic rate and degree of lymph node(LN)were evaluated and the relation betweenprognostic significance and LN metastasis(M)wasanalysed through a retrospective study of 474 patientsundergoing resections of non-irradiated esophageal car-cinoma. In patients with LNM, the LNM rate was44.5%. A total of 5382 LNs were resected and exam-ined pathologically; 690 of them were metastatic oneswith a LNM degree of 12.8%。 The 5-year survivalrate of this series was 30.6%(145/474),and was12. 8%(27/211) in patients with LNM and 44.9%(118/263)in those without LNM. We concluded thatsurgery remains the first choice of treatment for carci-noma of esophagus, and that meticulous LN dissectionis an important part of surgical oncology. This is espe-cially true when the cancer process is reasonably local-ized. However. in more advanced cases of this disease,surgery alone is of limited value in eradicating all can-cer compromized tissue, and therefore the routinepractice of extensive LN dissection in such cases maynot be rewarding.