胸段食管鳞状细胞癌淋巴结转移、肿瘤长度与预后的关系

Prognostic factors for the survival of patients with thoracic esophageal squamous cell carcinoma： the importance of tumor length and lymph node status

目的分析胸段食管鳞状细胞癌（简称食管癌）淋巴结转移的数量及其转移度、肿瘤长度与预后的关系。方法对1995年7月至2005年7月胸段食管癌根治术后患者526例，采用SPSS13．0软件对临床资料进行统计学生存分析。结果淋巴结转移数量〉3个者预后不良；淋巴结转移度〉20％者预后不良；肿瘤长度分3组（≤5cm、5cm〈长度〈7cm、〉7cm），各组1、3、5、10年生存率（84．44％、47．79％、36．90％、35．52％；73．51％、40．29％、23．87％、20．64％；64．44％、13．92％、0、0）比较差异有统计学意义（P=0．001）。结论胸段食管癌淋巴结转移数量、转移度及肿瘤长度与预后有重要关系，能反映其预后，建议pTNM分期将淋巴结转移数考虑在内。

Objective To investigate the effect of tumor length and number of positive lymph nodes and the ratio of positive lymph nodes on survival in patients with esophageal squamous cell carcinoma. Methods From July 1995 to July 2005, a total of 6,691 resected lymph nodes were obtained from 526 patients who underwent ,curative resection of the primary tumour with systematic lymphadenectomy. The survivals were analysed by life tables and Kaplan-Meier methods. Results Among patients with regional disease, the number of positive lymph nodes （〉3） was related to an increasing risk. The proportion of positive lymph nodes compared with the number of lymph nodes dissected （20 %） conferred an increased risk. The tumor length （≤5 cm, 5 cm 〈 length 〈 7 cm, 〉7 cm） was related to an increasing risk （84.74 %, 47.79 %, 36.90 %, 35.52 %; 73.41%, 46.29 %, 23.87 %, 20.64 %; 64.44 %, 13.92 %, 0, 0）. Conclusion Tumor length, the number of positive lymph nodes, and the ratio of positive lymph nodes are important prognostic factors for survival in patients with esophageal carcinoma. The PTNM classification system for patients with esophageal carcinoma might consider adding number of positive lymph nodes as an important prognostic factor.