食管癌术后淋巴结转移规律分析

Analysis on regularity of lymph node metastasis after operation of esophageal carcinoma

目的探讨食管癌淋巴结转移的影响因素并了解食管癌术后区域淋巴结转移的分布规律。方法收集我院2001至2009年经手术治疗102例发生区域淋巴结转移的食管癌患者的临床资料,对影响淋巴结转移的因素行单因素分析及Logistic回归分析。对术后发生区域淋巴结转移的病例,按纵隔淋巴结分区标准,以食管的分段分组,统计区域淋巴结转移在各分区中的分布。结果在102例食管癌患者中,术后病理证实有阳性淋巴结转移50例(49.0%)。肿瘤浸润深度、病变长度和肿瘤所在部位不同对淋巴结转移率的影响有统计学意义(P<0.05)。年龄和肿瘤分化程度不同对淋巴结转移率的影响无统计学意义(P>0.05)。Logistic多因素回归分析显示,病变长度、浸润深度和病变部位是判断淋巴结转移的独立因素。102例患者术后共计有132个区域淋巴结转移,下颈区59个(44.70%),上纵隔区51个(38.64%),主动脉肺窗区1个(0.76%),前纵隔区1个(0.76%),隆突下区5个(3.79%),中下段食管旁区3个(2.27%),肺门区3个(2.27%),腹部区9个(6.82%)。结论病变长度、浸润深度和病变部位是影响食管癌淋巴结转移的因素,病变越长,浸润越深,病变部位越低,淋巴结转移率越高;食管癌术后区域淋巴结转移主要分布在下颈区及上纵隔区,是术后放疗的重点。

Objective To study the relative factors of lymph node metastasis of esophageal carcinoma, and to analyze the distribution rule of lymph node metastasis of post esophageetomy patients for guiding the radiotherapy. Methods To collect the patients＇ data （ 102 cases） in our hospital from 2001 to 2009, who were found lymph node metastasis confirmed by pathology in a certain period of time after esophageal cancer surgery. The factors affected the lymph node metastasis in esophageal cancer were analyzed by single logistic regression and Logistic regression method. To analyze the rule of postoperative lymph node metastasis in different regions, according to the lymph node partition, in accordance with paragraphs of esophageal cancer in different groups. Results Of the 102 patients after esophageal cancer surgery, who were confirmed by pathological examination, 50 cases had positive lymph node metastasis, 52 cases had negative, and the lymph node metastasis rate was 49.0%. Lymph node metastasis rates of different depth, length and paragraph of tumor invasion had statistical differences（ P 〈 0. 05 ）. The impact on lymph node metastasis rates of the different age and degree of differentiation had no statistical difference （ P 〉 0. 05 ）. Muhivariate logistic regression analysis showed that the lesion length, depth of invasion and paragraph of tumor were meaningful factors affecting the lymph node metastasis. Of the 102 patients, 132 sites node metastasis were found by imaging study and histopathology with supraelavicular node 59 （44. 70% ）, upper mediastinum node 51 （38.64%）, A-P windows node 1 （0.76%）, anterior mediastinum node 1 （0.76%）, subearinal node 5（3.79% ）, middle and lower thoracic paraesophaguse node 3 （2. 27% ） , hilar node 3 （2. 27% ） , and abdominal area node 9 （6. 82% ）. Conclusion The length and depth of invasion,and paragraph of esophageal cancer are meaningful factors that affect the lymph node metastasis. The longer of lesion, deeper of infiltration and lower of pragraph, the easier to get independent lymph node metastaisis. The postoperative lymph node metastasis is mainly distributed in the lower neck area and upper mediastinal area, which is the focus of postoperative radiotherapy.