食管癌食管气管沟淋巴结转移CT表现及与预后关系

CT features of tracheoesophageal groove lymph node metastasis and its prognostic value in esophageal carcinoma

目的:回顾分析食管癌食管气管沟淋巴结转移的CT表现及其与放疗预后的关系。方法:对2004年至2008年有完整临床和CT资料并有病理证实且放疗前均无远处转移,放疗后随访2年以上的食管癌食管气管沟淋巴结病例152例,分析其CT表现和预后情况,Kaplan-Meier法生存分析。152例均接受放射治疗,采用60Co、X射线照射,DT 50-70Gy,25-35次,35-49天,少数合并化疗。结果:各段食管癌均可发生食管气管沟淋巴结转移,CT是确诊的可靠方法。食管气管淋巴结转移右侧较左侧多。2年局部控制率轻度、中度强化相似(69.2%,57.1%,P﹥0.05),密度均匀型好于小低密度和边缘强化内部坏死型(72.9%,54.0%,31.3%,P<0.05,P<0.05),边缘规则者好于边缘不规则和明显外侵者(73.9%,37.2%,33.3%,P<0.05,P<0.05)。结论:食管癌食管气管沟淋巴结转移、转移淋巴结强化程度高、密度不均匀、边缘不规则或外侵的局部控制率明显下降,据此可以粗略判断预后。

Objective：To investigate the characteristics and prognostic value of computed tomography（CT） of tracheoesophageal groove lymph node（TGLN） in esophageal carcinoma.Methods： From 2004 to 2008,we analyzed CT images of 152 patients with histologically proven TGLN treated with radiation therapy in our hospital.The survival rate was evaluated by Kaplan-Meier method.All patients were treated with radiotherapy.The majority of patients were given（50-70）Gy/[（25-35） F·（35-49）d].The minority were treated with the combination of radiotherapy and chemotherapy.Results： TGLN metastasis could arise from carcinoma in any segment of the esophagus.CT should be a reliable method of diagnosis.The TGLN metastasis on the right side is more common than on the left side.The 2-year local control rate between the mild and moderate enhancement of TGLN was similar（69.2%,57.1%,P0.05）.The survival rate of TGLN with homogeneous density was better than heterogeneous density respectively（72.9%,54.0%,31.3%,P0.05,P0.05）.The survival rate of patients with well boarded TGLN was better than those with ill boarded TGLN and obviously adjacent tissue involvement（73.9%,37.2%,33.3%,P0.05,P0.05）.Conclusion： The prognosis could be roughly determined by TGLN metastasis,lymph node enhancement,heterogeneous density in nodes and ill board TGLN.