胸段食管鳞癌淋巴结转移对放疗临床靶区设计影响的探讨

Metastasis of lymph node for squamous cell carcinoma of thoracic esophagus and its implication in delineation of clinical target volume for radiation therapy

目的:分析胸段食管鳞癌淋巴结转移规律及临床病理因素与淋巴结转移的相关性,为胸段食管鳞癌放疗临床靶区的勾画提供一定的参考。方法:描述经手术治疗的2 067例胸段食管鳞癌患者的病理特点,χ2检验分析各临床病理因素与淋巴结转移的相关性,对单因素分析有统计学意义的因素进行多因素Logistic回归分析。结果:食管癌肿瘤长度(χ2=44.629,P<0.01)、浸润深度(χ2=23.013,P<0.01)及分化程度(χ2=18.622,P<0.01)与淋巴结转移具有相关性。多因素Logistic回归分析结果显示,肿瘤长度(OR=1.339,95%CI为1.217～1.474)、浸润深度(OR=1.253,95%CI为1.115～1.409)和分化程度(OR=1.366,95%CI为1.182～1.579)是影响胸段食管癌淋巴结转移的独立危险因素。T1～T2期的胸中段食管癌中纵膈、胸下段食管癌下纵隔和腹腔淋巴结转移率分别为18.6%、34.5%和20.4%。T3～T4期胸中段食管癌中纵膈和腹腔淋巴结转移率分别为42.4%和18.8%;胸下段中纵膈、下纵隔和腹腔淋巴结转移率分别为21.1%、43.4%和30.0%。高分化胸中段食管癌中纵膈及低分化胸中段食管癌中纵膈、下纵膈和腹腔淋巴结转移率分别为34.8%、17.6%、38.5%和27.4%;低分化胸中段食管癌中纵膈和腹腔淋巴结转移率分别为46.9%和29.1%,胸下段中纵膈、下纵隔和腹腔淋巴结转移率分别为28.3%、55.6%和29.3%。结论:勾画胸段食管鳞癌的放疗靶区时,应综合考虑肿瘤浸润深度、分化程度和肿瘤长度等因素,对淋巴结转移高危区域进行选择性照射。

OBJECTIVE： To investigate the metastasis regularity of thoracic oesophagus squamous cell carcinoma lymph nodes and its implication in delineation of clinical target volume for radiation therapy. METHODS： The clinical ma- terials of 2 067 patients having undergone radical resection on the squamous cell carcinoma of thoracic esophagus were ret- rospectively analyzed. The relationship between the clinieopathological factors and the lymph node metastasis was evalua- ted using the Chi-square test. For multivariate analysis,the forward step-wise procedure was performed using a binary lo- gistic regression model containing all statistically significant variables in Chi-square test. RESULTS.. Length of tumor （2 = 44. 629, P〈0.01）, depth of tumor invasion （X2 = 23. 013, P〈0.01）, and histological differentiation （X2 = 18. 622, P〈0. 01） were strongly associated with lymph node metastasis. The logistic regression analysis showed that length of tumor （OR=I. 339,95%CI：1. 217-1. 474） ,depth of tumor invasion （OR=I. 253,95%CI：1. 115-1. 409） and histologi- cal differentiation （OR= 1. 366,95 % CI：I. 182- 1. 579） were independent risk factors of lymph node metastasis. For T1 -T2 middle thoracic tumors, the rate of metastasis was 18.6 % middle mediastinal. For T1 --T2 lower thoracic tumors, the rate was 34.5 % lower mediastinal and 20.4 % abdominal. For T3 -T4 middle thoracic tumors, the rate was 42.4 % middle mediastinal and 18.8%%0 abdominal. For T3 -T4 lower thoracic tumors,the rate was 21.1% middle mediastinal and 43.4 % lower mediastinal and 30.0 % abdominal. For middle thoracic tumors patients with well differentiated tumors,therate of metastasis was 34.8% middle mediastinal,For lower thoracic tumors patients with well differentiated tumors, the rate of metastasis was 17.6 % middle mediastinal and 38.5 % lower mediastinal and 27.4 % abdominal. For middle thoracic tumors patients with poorly differentiated tumors, the rate of metastasis was 46.9 % middle mediastinal and 29.1% ab- dominal. For lower thoracic tumors patients with poorly differentiated tumors, the rate of metastasis was 28.3% middle mediastinal and 55.6 % lower mediastinal and 29.3% abdominal. CONCLUSION： Multiple clinicopathologic factors should be considered comprehensively to design the CTV for radiotherapy of thoracic oesophagus squamous cell carcinoma.