胸段食管癌淋巴结转移度与临床病理因素相关性分析

Correlation between Lymph Node Metastasis and Clinical Pathological Features of Intrathoracic Esophageal Cancer

目的 探讨胸段食管癌淋巴结转移度与主要临床病理因素的相关性及临床意义。方法 分析2004年7月至2005年6月409例食管癌患者的病例资料，其中胸上段癌58例，中段癌267例，下段癌84例。临床分期0～Ⅰ期23例，Ⅱa期199例，Ⅱb期31例，Ⅲ期139例，Ⅳ期17例，均行手术切除肿瘤及淋巴结清扫。术后分析淋巴结转移情况，对主要病理因素进行统计学处理。结果 全组术后病理示淋巴结转移率45．72％，总淋巴结转移度15．32％。统计分析显示随着肿瘤长径增加、浸润深度加深、分化程度降低，淋巴结转移度呈增高趋势，髓质型较其他大体类型、中下段食管癌较胸上段癌，淋巴结转移度增高。结论 肿瘤长度〉5cm、浸润深肌层以外、中低分化程度、髓质型病变以及中下段食管癌者，淋巴结转移度显著增高，于术前分期、手术方式选择、淋巴结清扫以及手术前后综合治疗中应予重视。

Objective To investigate the correlation between lymph node metastasis and clinical pathological features of intrathoracic esophageal cancer. Methods 409 cases of esophageal cancer were retrospectively reviewed, tumor situated at upper section in 58 cases, middle section in 267 cases and lower section in 84 cases. Clinical stage was 0 - Ⅰin 23 cases, Ⅱ a in 199 cases, Ⅱ b in 31 cases, Ⅲ in 139 cases and Ⅳ in 17 cases, all of which underwent tumor resection and lymphatic clearance. The lymphatic metastasis and clinical pathological features were investigated statistically. Result The overall incidence rate of lymph node involvement was 45.72%, and the lymphatic metastasis was more likely occurred in the presence of bigger tumor, more infiltration extension, lower grade of differentiation, medullary type pathologically and mid-lower section. Conclusion The higher lymphatic involvement is associated with tumor with more than 5 cm in diameter, infiltration beyond muscular layer, medium and low grade of differentiation, medullary pathological type and middle and lower section of tumor site.