胸中段食管癌术后淋巴结转移的特点

Characteristics of lymph node metastasis in middle esophageal carcinoma after two-field lymph node dissection

目的分析胸中段食管癌二野淋巴结清扫术后淋巴结转移规律,为术后放疗的勾画提供帮助。方法回顾性分析92例胸中段食管癌术后淋巴结转移患者的临床资料。依据放疗前定位CT,分析各区域淋巴结转移情况。结果纵隔淋巴结转移最为多见,转移比例为81.5%(75/92),其次为锁骨上淋巴结转移,为43.5%(40/92),腹部淋巴结转移最少,为12.0%(11/92),3组间比较差异有统计学意义(P=0.000)。上纵隔淋巴结转移比例达76.1%(70/92),占纵隔淋巴结转移的93.3%(70/75),主要分布于气管旁:1R区44.6%(41/92),2R区28.3%(26/92),4R区18.5%(17/92),1L区13.0%(12/92),2L区14.1%(13/92),4L区15.2%(14/92)。左气管旁区(1L区、2L区、4L区)淋巴结转移比例为31.5%(29/92),右气管旁区(1R区、2R区、4R区)淋巴结转移比例为60.9%(56/92),两组比较差异有统计学意义(P=0.000)。锁骨上左右气管旁淋巴结转移比例分别为7.6%(7/92)、16.3%(15/92),分别占锁骨上淋巴结转移的17.5%(7/40)、37.5%(15/40)。结论胸中段食管癌术后淋巴结转移的高危区是颈部与中上纵隔,提示胸中段食管癌术后辅助放疗靶区应以锁骨上及上纵隔,尤其是气管旁为主。

Objective To investigate the characteristics of lymph node metastasis in middle esophageal carcinoma after two-field lymph node dissection. Methods The local-regional recurrence in 92 cases with middle esophageal carcinoma after radical surgery was reviewed. The sites of lymph node metastasis were analyzed. Results Among 92 cases with lymph node metastasis, the mediastinal metastasis （75/92） was significantly higher than supraclavicular metastasis （40/92） and abdominal metastasis （ 11/92 ） （ 81.5 % vs 43.5 % and 12%, P = 0. 000）. Furthermore, the relative metastasis rate in upper mediastinum （70/92） was significantly higher than that of middle mediastinum （36/92） and the lower mediastinum （2/92） （76.1% vs 39.1% and 2.2% , P = 0. 000）. The metastasis rate of left paratracheal lymph nodes was 31.5% （29/92） including 1L, 2L and 4L regions; 60. 9% （56/92） cases with right paratracheal lymph nodes, includinglR, 2R and 4R regions. The metastasis of right supraclavicular paratracheal lymph nodes was significantly higher than that of left supraclavicular paratracheal lymph nodes （37.5 % vs 17.5 % ,P = 0. 026 ）. Conclusions The most common metastatic sites are para-bronches nodes in supraclavicular region, upper and middle mediastinum in middle esophageal cancer after radical surgery.