贲门癌的临床病理特点和淋巴转移规律的探讨

Clinicopathologic characters and lymphatic metastasis of cancers at the gastroesophageal junction

目的总结贲门癌的临床病理特点,探讨贲门癌淋巴转移规律。方法对我院在2000年10月至2004年12月间收治的86例贲门癌患者的临床资料进行回顾性分析。结果本组病例中男性66例,女性20例,平均60岁,以BorrmannⅢ型病例为主,组织学类型绝大部分是腺癌,Ⅰ型贲门癌高分化腺癌的发病率显著高于其他两型(P=0．002、P=0．004);Ⅲ型贲门癌在低分化腺癌中的发病率高于其他两型(P=0．005、P=0．015)。贲门癌第1、2组(34．9％),第3、4组(36．0％),第7-9组(27．9％),第10、11组(15．1％)淋巴结的转移率较高,而第5、6组(11．6％),第12组淋巴结(5．8％)的转移率较低(与同站其余淋巴结组比较,P值均小于0．05)。腹主动脉旁淋巴结转移率很高(58．3％);胃大弯侧和小弯侧之间的淋巴结转移率差异无统计学意义。3型贲门癌阳性淋巴结最远站别和pT分期正相关(r1=0．515,P1=0．05;r2=0．404,P2=0．006;r3=0．423,P3=0．031)。结论贲门癌根治术中应确保清扫第1-4组和第7-11组淋巴结,早期诊断有可能改善贲门癌的预后。

Objective To summarize the clinicopathologic characters and the route of lymphatic metastasis of cancers at the gastroesophageal junction. Methods Clinicopathologic data of 86 cancer patients treated from October 2000 to December 2004 were analyzed retrospectively. Results There were 66 males and 20 females, the mean age was 60 years. Most patients were of Bormann type Ⅲ adenocarcinoma. The incidence of high differentiated adenocarcinoma in Type Ⅰ cancer was higher than that in other two types （ P = 0. 002, P = 0. 004 ）, while the incidence of poor differentiated carcinoma in type Ⅲ cancer was higher than other two types（ P = 0. 005, P = 0. 015 ）. Metastatic rate of lymph nodes in group 1 and group 2（34. 9% ） ,group 3 and group 4（36. 0% ） , group 7 through to group 9（27. 9% ） , group 10 and 11（ 15. 1% ） was higher than in other groups, while that in group 5 and 6（ 11.6% ） , and group 12（5. 8% ） was lower compared with other lymph nodes （ P 〈0. 05 ）. Lymphometastatic rate in greater curvature was similar to that in lesser curvature. 58.3% group 16 lymph node was involved. In type Ⅲ carcinoma there was a positive correlation between the furthermost metastatic lymph node group and the T status of cancer （r1 =0.515,P1 =0.05;r2 =0.404,P2 =0.006;r3 =0.423,P3 =0.031）. Conclusion In the surgery for carcinoma of gastroesophageal junction, lymph nodes in group 1 -4 and group 7 - 11 should be removed.