食管胃结合部腺癌下胸部淋巴结转移临床分析

Clinical analysis of inferior thoracic lymph node metastasis in adenocarcinoma of esophagogastric junction

目的:分析食管胃结合部腺癌下胸部淋巴结转移的影响因素。方法:选择我院2008年10月至2011年4月期间经手术及病理确诊的食管胃结合部腺癌255例,其中经左胸入路手术81例,经腹手术174例,所有患者均行胃周淋巴结及下胸部淋巴结清扫。选取年龄、性别、Siewert分型、Borrmman分型、组织学类型、肿瘤大小、食管侵犯长度、肿瘤浸润深度以及TNM分期临床特征因素,分析其与下胸部淋巴结转移之间的相关性。结果:202例(79.2%)患者存在胃周淋巴结转移,其中19例(7.5%)同时伴随下胸部淋巴结转移。与非下胸部淋巴转移组(n=236)相比,下胸部淋巴结转移组(n=19)具有食管侵犯长度更长、TNM分期更晚的特点(P<0.05),同时两组在Siewert分型方面也有统计学意义。下胸部淋巴结转移危险因素的Logistic回归分析:食管侵犯长度及肿瘤TNM分期对淋巴结转移具有显著性影响(P<0.05),OR分别为:30.1、17.3。结论:AEG的下胸部淋巴结转移率低,其转移与否同肿瘤的Siewert分型、食管侵犯长度、肿瘤的TNM分期密切相关。

Objective：To analyze the critical influence factors on inferior thoracic lymph node metastasis of adenocarcinoma of esophagogastric junction patients.Methods：Clinical data from 225 patients with adenocarcinoma of esophagogastric junction in our institution from October 2008 to April 2011 were collected.81 patients underwent left thoracotomy approach surgery,and 174 cases underwent abodominal surgery.All cases underwent perigastric and inferior thoracic lymphadenectomy.Factors including age,gender,Siewert type,Borrmman type,histological type,tumor size,the length of esophageal invasion,depth of tumor invasion and TNM staging were analyzed.And their relationship with inferior thoracic lymph node metastasis was examined.Results：The perigastric lymph node metastases were found in 202 cases（79.2%） and 19 patients（7.5%） were combined with inferior thoracic node metastasis.Patients with inferior thoracic node metastasis showed longer length of esophageal invasion and more advanced TNM stages when compared to no inferior thoracic node metastatic group（P＜0.05）.Moreover,there was statistical significance of Siewert type between these two groups.Results of Multiple Factors Logistic Regression Analysis showed that the length of esophageal invasion and TNM staging influenced the metastasis（P＜0.05）,and OR were 30.1 and 17.3 respectively.Conclusion：The inferior thoracic node metastatic rate is low among AEG patients and whether there is inferior thoracic node metastasis or not closely correlated with Siewert type,the length of esophageal invasion and TNM staging.