食管癌纵隔喉返神经旁淋巴结转移对颈部淋巴结转移的影响

Para-recurrent lymph node metastasis was a significant predictor for cervical lymph nodes metastasis in thoracic esophageal carcinoma

目的探讨食管癌术后颈部淋巴结转移的危险因素。方法用Logistic法回归分析本院胸段食管鳞癌术后区域淋巴结转移患者126例的临床资料，探寻食管癌术后颈部淋巴结转移的危险因素。结果全组颈部淋巴结转移比例为43．7％（55／126）。Logistic回归分析显示原发部位、T分期、N分期、病理分级、淋巴结转移率、淋巴结转移度、淋巴结转移区域数与颈部淋巴结转移均无关。上纵隔右、左1区淋巴结转移是颈部右、左I区淋巴结转移的高危因素（X2=12．14、9．27，P=0．000、0．002），左纵隔喉返神经区淋巴结转移可降低右颈部I区淋巴结转移风险（X2=6．04，P=0．014），颈部Ⅲ区和上纵隔2区淋巴结转移是颈部Ⅱ。区淋巴结转移的高危因素（X2=14．56、8．27、8．02、3．93，P=0．000、0．004、0．005、0．047）。结论纵隔喉返神经旁淋巴结转移是颈部淋巴结转移的高危因素。

Objective To evaluate correlation factors of cervical lymph nodes metastasis in thoracic esophageal carcinoma. Methods Local-regional metastasis of lymph node for 126 cases with esophageal squamous cell cancer after surgery from 2004 to 2009 were reviewed. Risk factors of cervical lymph nodes metastasis were examined by multiple Logistic regression analysis. Results In 126 cases, supraclavicular lymph node metastasis rate was 43.7% （55/126）. By logistic regression, none of the primary site, T stage, N stage, histological grade, lymph node metastasis rate, lymph node metastasis degree and number of lymph nodes metastatic field was not the high risk of cervical lymph nodes metastasis. In addition, multivariate analysis found that lymph node metastasis in mediastinum region 1 was high risk factor for lymph node metastasis of region I （ X2 = 12. 14,9. 27,P = 0. 000,0. 002 ） ,lymph node metastasis in region HI and region 2 were high risk factors for lymph node metastasis of region IIa （X2 = 14. 56,8.27,8.02,3.93, P = 0. 000, 0. 004,0. 005,0. 047）. Conclusion Mediastinal para-recurrent nerve lymph node metastasis is a significant predictor for cervical lymph nodes metastasis.