胸部食管癌转移淋巴结数与预后的临床研究

The number of lymph node with metastases influences survival in patients with cancer of the thoracic esophagus

目的 探讨胸部食管癌转移淋巴结的个数与预后的关系。方法 采用颈、胸、腹三切口施行胸部食管癌手术 112例 ,同时施行三区域淋巴结清扫。选择 9个可能对食管癌切除术后预后产生影响的特征性临床因素 ,通过Cox比例风险模型 ,利用累计生存率对食管癌切除术后患者进行预后多因素分析。结果 本组总 5年生存率为 5 8.4% ,其中无淋巴结转移组 (A组 )为 88 4%、转移淋巴结1～ 3枚组 (B组 )为 5 0 8% ,转移≥ 4枚组 (C组 )为 2 0 8%。影响预后的主要因素是淋巴结转移、肿瘤侵及深度、肿瘤分化程度和肿瘤的部位 (P <0 .0 5 ) ,且转移淋巴结数与肿瘤的浸润程度、分化程度、转移的区域以及生存率等密切相关 (P <0 .0 0 1)。

Objective To study the extent of lymph node involvement in relation to survival of patients with thoracic esophageal carcinoma.Methods From 1990 to 1993, there were 112 patients with thoracic esophageal carcinoma undergone esophagectomy through right thoracotomy and three field lymphadenectomy. They were classified into three groups: group A, 44 patients without lymph node involvement; group B, 36 patients with 1 to 3 positive nodes; group C, 32 patients with ≥4 involved lymph nodes. Nine possible factors influencing survival were studied . A multivariate analysis of these variables was performed using the cummulative survival rate by the computer′s Cox proportional hazard model. Results The over all cumulative survival rate was 58.4% at 5 years. That for patients in group A, B and C was 88.4%, 50.8% and 20.8%, respectively. Apart from the extent of lymph node metastases, depth of tumor invasion, location and differentiation of tumor were of prognostic significance.Conclusion Lymph node metastasis is the major factor affecting survival of patients with cancer of the thoracic esophagus.