胸段食管癌淋巴结转移数量对预后的影响分析

Study on prognostic significance of lymph node metastasis in carcinoma of thoracic esophagus

目的探讨胸段食管癌转移淋巴结的数量与食管癌预后的关系以及影响淋巴结转移数量的因素。方法回顾性分析1996年10月至2000年8月在山西省肿瘤医院行胸段食管癌根治术后患者282例。所得结果采用SPSS13.0软件包进行生存分析。结果(1)食管癌无淋巴结转移者1、3、5年生存率分别为80.65%、50.12%、36.70%;有淋巴结转移者1、3、5年生存率分别为65.35%、22.46%、7.94%,两者差异具有统计学意义;(2)淋巴结转移数量与食管癌的生存率呈负相关;(3)淋巴结转移的数量与癌组织的分化、长度、周径及是否有癌栓有关。结论食管癌淋巴结转移数量与该病预后有重要关系,能反映其预后,建议pTNM分期将淋巴结转移数考虑在内。

Objective To explore the effect of number of positive lymph nodes on survival in patients with esophageal carcinoma,and to evaluate the influence factors of positive lymph nodes number.Methods From October 1996 to August 2000,a total of 2807 resected lymph nodes were obtained from 282 patients who underwent curative resection of the primary tumour with systematic lymphadenectomy at Shanxi Cancer Hospital.The survivals were analysed by life tables and Kaplan-Meier methods,the related factors of lymph node metastasis were assessed by Chi-square test.Results The 1-year,3-year,and 5-year survival for node-negative patients was 80.65 %,50.12 %,36.70 % versus 65.35 %,22.46 %,7.94 % for node-positive patients.The number of positive lymph nodes was negative related to survival rates in carcinoma of thoracic esophagus.The number of positive lymph nodes was positive related to metastatic lymph node ratio.Metastatic lymph node ratio,location of metastatic lymph node were not associated with survival rates in carcinoma of thoracic esophagus.The risk of the number of positive lymph node metastasis was significantly influenced by length,histologic grade,circumference and lymphangial tumor-cells thrombus.Conclusion The number of positive lymph node can better reflect the prognosis of patients.The authors suggested a modification of the tu- mor-lymph node-metastasis(TNM)staging classification(ypTNM)to include the number of positive lymph nodes in the ypN1 category.