393例食管胃结合部腺癌淋巴结转移的特征及其影响因素

Patterns and influencing factors of lymph node metastasis of adenocarcinoma of the esophagogastric junction in 393 patients

目的：探讨食管胃结合部腺癌（ AEG）的淋巴结转移规律及其影响因素。方法收集行根治性手术切除、胸腹二野淋巴结清扫术的393例AEG患者的资料，手术共清扫淋巴结5119枚，平均13枚。分析不同Siewert分型患者的淋巴结转移分布情况以及临床病理因素对淋巴结转移的影响。结果全组患者的淋巴结转移率为70．0％（275／393），淋巴结转移度为29．1％（1492／5119）。Siewert各分型AEG均主要向下转移至腹部淋巴结，并可向上转移至纵隔淋巴结，其中Ⅰ型转移率最高，Ⅱ型次之，Ⅲ型最低。 T1期患者无淋巴结转移，T2、T3、T4期患者的淋巴结转移率分别为29．4％、75．0％和74．6％，转移度分别为10．1％、14．4％和32．0％，随浸润深度的增加，淋巴结转移率和转移度均增高（均P＜0．05）。低分化组和中高分化组患者的淋巴结转移率分别为79．3％和61．7％，转移度分别为36．0％和22．1％，差异均有统计学意义（均P＜0．001）。肿瘤最大径≥4 cm组和＜4 cm组患者的淋巴结转移率分别为73．1％和46．8％，转移度分别为30．9％和14．6％，差异均有统计学意义（均 P＜0．001）。有脉管瘤栓和无脉管瘤栓患者的淋巴结转移率分别为84．6％和67．1％，转移度分别为44．8％和26．0％，差异均有统计学意义（均P＜0．05）。黏液腺癌及印戒细胞癌患者的淋巴结转移度为34．9％，明显高于腺癌患者（28．5％，P＜0．001）。肿瘤浸润深度和分化程度是影响AEG淋巴结转移的独立因素（均P＜0．001）。结论 AEG的淋巴结转移率和转移度均较高，不同Siewert分型有各自的淋巴结转移特点。 AEG的淋巴结转移受多种因素影响，其中肿瘤浸润深度和分化程度是其独立的影响因素。

Objective To explore the patterns and influencing factors of lymph node metastasis of adenocarcinoma of the esophagogastric junction （ AEG ） . Methods Clinicopathological data of 393 AEG patients who underwent radical resection and lymphadenectomy in the thoracic or abdominal cavity were collected. We analyzed the metastatic patterns of 5 119 excised lymph nodes with an average of 13 nodes per patient according to Siewert classification, and the associations between lymphatic metastasis and clinicopathological factors, such as tumor invasion, differentiation, maximum diameter, or pathological type were analyzed. Results The lymph node metastasis rate and ratio （ LNR） were 70. 0% （ 275/393） and 29.1% （1 492/5 119）, respectively. All the Siewert subtypes of AEG mainly metastasize downwards to the abdominal lymph nodes, while also spread upwards to the mediastinal lymph nodes. Among them, the lymph node metastasis rate was highest in Siewert type Ⅰ and lowest in Siewert type Ⅲ AEG. The lymph node metastasis rate and ratio in T1, T2, T3, T4 AEGs were 0%, 29. 4%, 75. 0%, 74. 6% and 0%, 10. 1%, 14.2%, 32.0%,respectively （χ^2=35.305,P〈0.001 and χ^2=134.034,P〈0.001） . The lymph node metastasis rate and ratio of the poorly differentiated adenocarcinoma were 36.0% and 79.3%, respectively, significantly higher than 22.1% and 61.7% of the well？differentiated adenocarcinoma （χ^2=14.468, P〈0.001 and χ^2=120.009, P〈0.001）. The lymph node metastasis rate and ratio of patients with a tumor in maximum diameter≥4 cm were 73.1% and 30.9%, significantly higher than 46.8% and 14.6%, respectively, in the patients with a tumor in maximum diameter of〈4 cm （χ^2=13.636, P〈0.001 andχ2=64.767, P〈0.001） . The group＆amp;nbsp;of vascular tumor thrombus showed significantly higher lymph node metastasis rate and ratio than those in the group with no vascular tumor thrombus （ 84. 6% versus 67. 1%, χ^2=7. 946, P=0. 005; and 45. 0% versus 26.0%, χ2 = 112. 723, P〈0. 001 ） . The lymph node metastasis ratio of mucinous and signet ring cell adenocarcinoma was 34.9%, significantly higher than 28.5% of the adenocarcinoma （χ^2=8.710, P〈0.001） The depth of tumor invasion and degree of tumor differentiation were independent factors affecting lymph node metastasis （P=0.001 and P〈0.001）. Conclusions The lymph node metastasis rate and ratio of AEG are high and influenced by many clinicopathological factors. The patterns of lymph node metastasis are different among different Siewert subtype AEGs.The depth of tumor invasion and differentiation degree are independent factors affecting lymphatic metastasis.