局限期食管小细胞癌的淋巴结转移规律及影响因素

Lymph node metastasis patterns and influencing factors in patients with limited esophageal small cell carcinoma

目的探讨局限期食管小细胞癌（PESC）患者的淋巴结转移规律及其影响因素。方法收集河北医科大学第四医院手术治疗的98例局限期PESC患者的临床资料，分析不同病变部位PESC的淋巴结转移度及病变浸润深度、病变长度等因素对淋巴结转移的影响。结果46例患者发生淋巴结转移，淋巴结转移率为46．9％（46／98）。手术共清扫淋巴结833枚，100枚发生淋巴结转移，淋巴结转移度为12．0％（100／833）。胸上段PESC上纵隔、中纵隔、下纵隔和腹腔淋巴结转移度分别为42．9％、12．5％、0和0；胸中段PESC上纵隔、中纵隔、下纵隔和腹腔淋巴结转移度分别为18．8％、7．7％、15．7％和15．3％；胸下段PESC上纵隔、中纵隔、下纵隔和腹腔淋巴结转移度分别为0、0、27．3％和23．5％。T1、T2、T3和T4期患者的淋巴结转移率分别为15．4％、42．3％、63．9％和80．0％，淋巴结转移度分别为2．0％、8．3％、17．8％和25．0％；不同T分期患者的淋巴结转移率和转移度的差异均有统计学意义（均P〈0．05）。病变长度〈3cm组、3～5cm组和〉5cm组患者的淋巴结转移率分别为30．6％、46．9％和66．7％，淋巴结转移度分别为5．4％、11．0％和21．1％，不同病变长度患者的淋巴结转移率和转移度的差异均有统计学意义（均P〈0．05）。Chr—A阴性＋弱阳性组患者的淋巴结转移度为11．6％，明显高于Chr-A阳性组（4．3％，P=0．013）。NSE阳性组患者的淋巴结转移度较NSE阴性＋弱阳性组患者有增高趋势（P=0．069）。Logistic单因素分析未发现远隔区域淋巴结转移的危险因素（均P〉0．05）。多因素分析显示，肿瘤浸润深度是局限期PESC患者淋巴结转移的独立危险因素（P=0．002）。结论PESC早期即可发生淋巴结转移，转；眵部位多、范围广。胸上段PESC上纵隔淋巴结转移较为常见，胸下段PESC下纵隔及腹腔淋巴结转移较为常见，胸中段PESC淋巴结转移广泛。浸润深度和病变长度是纵隔淋巴结转移的主要影响因素，其中浸润深度是淋巴结转移的独立危险因素。

Objective To explore the patterns and influencing factors of lymph node metastasis in limited esophageal small cell carcinoma （PESCC）. Methods A total of 98 limited stage PESCC patients who underwent surgery were selected for this study. The lymph node metastasis ratio at different sites, depth of invasion, tumor length and other factors were analyzed to assess their influence on lymph node metastasis. Results Among the 98 PESCC cases, 46 cases had lymph node metastasis （46.9%）. 100 out of 833 lymph nodes had metastasis, with a metastasis ratio of 12.0%. For upper thoracic esophageal small cell carcinomas, lymph node metastasis ratios were 42.9%, 12.5%, 0 and 0 in the superior mediastinum, middle mediastinum, inferior mediastinum and abdominal cavity, respectively. In the middle thoracic PESCCs, the lymph node metastasis ratios were 18.8%, 7.7%, 15.7%, and 15.3%, respectively. In the lower thoracic PESCCs, the lymph node metastasis ratios were 0, 0, 27.3% and 23.5%, respectively. Lymph node metastasis rates in PESCCs at stages, T1, T2, T3, T4 were 15.4%, 42.3%, 63.9%, and 80.0%, respectively. The lymph node metastasis ratios in PESCCs at stages T1, T2, T3, T4 were 2.0%, 8.3%, 17.8% and 25.0%, respectively. Lymph node metastasis rate and lymph node metastasis ratio at different T stages were of significant difference （P〈0.05 for all）. Lymph node metastasis rates in patients with tumor 〈 3 cm, 3-5 cm, and 〉5 cm were 30.6%, 46.9% and 66.7%, respectively, and lymph node metastasis ratios were 5.4%, 11.0% and 21.1%, respectively. Lymph node metastasis rate and lymph node metastasis ratio in patients with different tumor length had significant differences （P〈0.05 for all）. Lymph node metastasis ratio was 11.6% in the Chr-A negative and weak positive group, much higher than 4.3% in the Chr-A positive group （P= 0.013）. There was a tendency that lymph node metastasis ratio of NSE-positive group was higher than that of NSE-negative and weak positive group （P = 0.069 ）. The logistic univariate analysis did not find high risk factors of distant lymph node metastasis （all P〉0.05）. Logistic multivariate analysis found that only depth of invasion was a risk factor of lymph node metastasis in limited PESCC（P=0.1302）. Conclusions Esophagus small eell eareinomas sometimes have early lymph node metastases in many sites and distant range. The middle thoraeie PESCCs tend to have extensive metastasis quite common in the upper mediastinal lymph nodes. Lower mediastinal and abdominal lymph node metastases are often seen in lower thoraeie PESCCs. The depth of invasion and tumor length are main factors influencing mediastinal lymph node metastasis. The depth of invasion is an independent risk factor for lymph node metastasis.