食管-胃结合部腺癌淋巴管侵犯与相关病理学因素关系研究

The Relationship between Lymphatic Vessel Invasion and Other Correlative Pathologic Factors in Adenocarcinoma of the Esophago-gastric Junction

目的:探讨食管-胃结合部腺癌淋巴管侵犯与相关病理学因素之间的关系。方法:对156例根治性手术切除的食管-胃结合部腺癌的病理资料进行分析,按照有无淋巴管侵犯分为两组(LV(I+)组89例,LV(I-)组67例),比较不同N分期、T分期、肿瘤大体类型、组织学类型、分化程度、肿瘤大小及淋巴结转移个数等情况下,淋巴管侵犯的发生情况(采用卡方检验,P<0.05差异具有统计学意义),并比较LV(I+)组与LV(I-)组肿瘤分化程度的差别(采用非参数Mann-WhitneyU检验)以及肿瘤大小和淋巴结转移个数的情况(采用两个独立样本的t检验,P<0.05差异具有统计学意义)。结果:1)LV(I-)组与LV(I+)组,LN(+)发生率分别为61.2%和95.5%,LV(I+)者淋巴结转移率高,差异具有统计学意义;LN(-)者与LN(+)者,LVI(+)发生率分别为13.3%和67.5%,LN(+)者发生淋巴管侵犯的几率较大,差异具有统计学意义。2)T1期均为LVI(-);T2及T3期LVI发生率无统计学差异;T4期LV(I+)者显著高于LVI(-)者。3)分化好组与分化差组的LVI发生率有统计学差异,分化差组中低分化腺癌LVI(+)明显高于LV(I-)。4)LV(I+)组平均肿瘤大小和平均淋巴结转移个数分别为(6.09+3.40)cm和(9.75+7.82)枚,LV(I-)组分别为(4.34+2.07)cm和(2.63+2.00)枚,两组间差异具有统计学意义。结论:食管-胃结合部腺癌的淋巴管侵犯发生与N分期、T分期、组织学类型、分化程度、肿瘤大小及淋巴结转移个数等多种病理学因素显著相关。

Objective： To investigate the relationship between lymphatic vessel invasion （LVI） and other correlated pathologic factors in adenocarcinoma of the esophago-gastric junction. Methods： A total of 156 patients with esophago-gastric junction adenocarcinoma who underwent radical surgical resection were recruited and divided into two groups： the LVI-positive group and the LVI-negative group. The incidence of LVI was evaluated with the X^2 test among patients with different N stages, T stages, morphological and histological type, tumor size and the number of involved lymph nodes. The difference in tumor differentiation between the LVI （＋） group and the LVI （-） group was compared by nonparametric Mann-Whitney U test. The tumor size and the number of lymph nodes with metastases [LN（＋）] were estimated between the LVI （＋） group and the LVI （-） group using the independent samples t test. Results： （1） The incidence of LN （＋） was 61.2% in the LVI （＋） group and 95.5% in the LVI （-） group, with a significant difference. The incidence of LVI was 13.3% in patients with involved lymph nodes and 67.5% in patients without involved lymph nodes, with a significant difference. （2） All cases of T1 stage were LVI （-）. No significant difference was found in the incidence of LVI between stages T2 and T3. Most T4 stage cases were LVI （＋）. （3） A statistical significance was found in the incidence of LVI between well-differentiated cases and poorly-differentiated cases. The poorly-differentiated cases were mostly LVI （＋）. （4） The tumor size was 6.09＋3.40 cm in the LVI （＋） group and 9.75＋7.82 in the LVI （-） group. The number of involved lymph nodes was 4.34＋2.07 in the LVI （＋） group and 2.63＋2.00 in the LVI （-） group. Conclusion： There is a significant correlation between LVI and N stage, T stage, the morphological and histological type, the tumor differentiation, tumor size and the number of involved lymph nodes.