食管鳞状细胞癌淋巴结转移对预后影响的分析

Study on Prognostic, Significance of Lymph Node Metastssis in Squamous Cell Carcinoma of Thoracic Esophagus

目的：探讨胸段食管鳞状细胞癌淋巴结转移数对预后的影响。方法：以 １１４６例胸段食管鳞状细胞癌单纯手术切除的临床病理资料，应用 Ｋａｐｌａｎ－Ｍｅｉｅｒ生存曲线和Ｓｐｅａｒｍａｍ相关进行研究。结果：１）０、１、 ≥２个转移淋巴结间的生存率差异显著（Ｐ＜０．００１）。２）Ⅱｂ期和Ⅲ期间的生存率无差异（Ｐ＞０．０５）；１和≥２个转移淋巴结的Ｔ３Ｎ１Ｍ０期间的生存率差异显著（Ｐ＜０．００１）；３）基于０、１和≥２个转移淋巴结的分期，该分期中的Ⅱａ期、Ⅱｂ期、Ⅲａ期和Ⅲｂ期之间的生存率差异显著（Ｐ＜０．００１）。结论：淋巴结转移数和基于淋巴结转移数的分期能够反映食管癌切除术预后的变化，但还需更大样本量和多中心的进一步研究。

Objective: To study the prognostic significance of the extent of lymph node metastasis in squamous cell carcinoma of thoracic esophagus. Methods: To analyse retrospectively the clinical and pathological materials of 1146 patients who had undergone resection of squamous cell carcinoma of thoracic esophagus. The survivals were analysed by Kaplan-Meter method and the related factors of lymph node metastasis were assessed by Spearmam correlation. Results: There was significant difference in survival among the patients without positive node, with one positive node, two or more positive nodes (P<0.001). There was no significant difference in survival between the patients with stage Ⅱ b and stage Ⅲ tumors (P>0.05). In T3N1M0 patients, there was significant difference in survival between the patients with one positive node and with two or more positive nodes (P<0.001). According to the number of lymph node metastasis, there was significant difference in survival among our suggesting stage groupings: Stage Ⅱ a (T3N0M0), stage Ⅱ b (T1N1M0), stage Ⅲ a (T2N1M0 and T3N1(1)M0) and stage Ⅲ b (T3N1(2)M0) and T4N0-1M0). Conclusion: The number of positive lymph nodes significantly influences the prognosis of the patients with squamous cell carcinoma of thoracic esophagus. The stage groupings can better reflect the prognosis of patients, but it should be confirmed by a bigger sample amount and multicentral study.