局限期食管小细胞癌淋巴结转移规律及临床意义初探

Pattern of lymph node metastasis in limited-stage primary esophageal small-cell carcinoma and its clinical significance： a preliminary study

目的探讨局限期原发食管小细胞癌（PESC）淋巴结转移规律及对指导放疗临床靶体积勾画意义。方法回顾2006--2012年在本院手术切除的21例局限期PESC患者临床资料，分析淋巴结转移率、转移度和空间分布规律。结果平均清扫淋巴结27．9个，15例患者出现淋巴结转移，其中弥散性分布8例、聚集性分布7例。淋巴结转移率为71．4％、转移度为17．2％。Logistic单因素分析结果显示T分期晚、食管原发灶较长是发生淋巴结转移的危险因素（P=0．004、0．044），T分期晚、脉管侵犯是淋巴结转移分布弥散性的危险因素（P=0．007、0．005）。结论PESC转移率和转移度均高于食管鳞癌。淋巴结转移弥散性分布占38％，依据T分期和脉管侵犯甄别淋巴结转移分布状况探讨PESC淋巴引流区域预防性照射价值值得研究。

Objective To study the pattern of lymph node metastasis （LNM） in limited-stage primary esophageal small-cell carcinoma （PESC） and its guiding significance for clinical target volume delineation in radiotherapy. Methods A retrospective analysis was performed on the clinical data of 21 patients with limited-stage PESC who underwent esophagectomy in our hospital from January 2006 to July 2012 to analyze the rate and degree of LNM and distribution of metastatic lymph nodes. Results The mean number of dissected lymph nodes per patient was 27.9. There were 15 patients who had LNM ;8 patients had dispersed distribution of metastatic lymph nodes, and 7 patients had aggregated distribution of metastatic lymph nodes. The LNM rate was 71.4%, and the LNM degree was 17.2%. The Logistic univariate analysis showed that advanced T stage and long PESC lesion were the risk factors for LNM （P =0. 004,P =0. 044） and that advanced T stage and angiolymphatic invasion were the risk factors for dispersed distribution of metastatic lymph nodes （P = 0. 007,P = 0. 005 ）. Conclusions The rate and degree of LNM are higher in PESC than in esophageal squamous cell carcinoma. Among the patients with limited-stage PESC, 38% have dispersed LNM. More research is recommended to evaluate the distribution of metastatic lymph nodes according to T stage and angiolymphatic invasion and investigate the value of prophylactic irradiation to the lymphatic drainage area of PESC.