食管癌的侵犯深度及分化程度与区域淋巴结转移的关系

Study on the relationship between depth of esophageal carcinoma invasion or histologic differentiation features and regional lymph node status

目的 :探讨食管癌的侵犯深度及细胞分化程度与区域淋巴结转移的关系。方法 :回顾性分析 1996年 5月至 1999年5月在我院行手术治疗的 470例食管癌患者临床及病理资料 ,比较肿瘤不同侵犯深度、细胞分化程度之间区域淋巴结转移情况的差异。 结果 :随着肿瘤侵犯深度的加深及细胞分化程度的降低 ,区域淋巴结的转移度呈显著上升趋势 (χ2 检验 ,P<0 .0 1)。一旦肿瘤侵犯超过深肌层 ,区域淋巴结的转移度显著增加 ,与侵及浅肌层相比 ,T2期肿瘤侵及深肌层者淋巴结转移度增加 10倍 ,T3期增加 17倍 ,T4期增加 2 3倍 ;与高分化食管癌相比 ,中分化癌淋巴结转移度增加 3倍 ,中低分化癌增加 4.5倍 ,低分化癌增加 6倍。结论 :食管癌患者肿瘤的侵犯深度及细胞分化程度是预计区域淋巴结转移状态的重要因素 ,在食管癌的临床分期、治疗方法的选择及预后判断方面起重要作用。

Objective: To study the relationship between the depth of esophageal carcinoma invasion (T) and regional lymph node metastasis(N), the histologic differentiation and N. Methods: A retrospective review of 470 consecutive patients undergone esophageal resection was conducted to define the relationship between T and N, histologic differentiation and N. Results: The likelihood of N 1 with increasing T and decreasing histologic differentiation were tested using χ 2 test( P <0.01). Once the shallow muscle layer was invaded, regional lymph node metastasis increased significantly. Compared with a T2(shallow muscle layer) patient, a T2(deep muscle layer) patient was 10 times more likely to have N 1, T3 patient 17 times, and T4 patient 23 times. Compared with well differentiated patient, a medium differentiated patient was 3 times more likely to have N 1, a medium low differentiated patient 4.5 times, a low differentiated patient 6 times. Conclusion: For patients with esophageal carcinoma, T and histologic differentiation are important predictors of N and those association play an important role in clinical staging and treatment decisions. [