淋巴结跳跃转移与胸段食管鳞癌预后相关性分析

Prognostic significance of lymph node metastasis in patients with squamous cell carcinoma of middle thoracic esophagus

目的近年来虽然食管鳞癌的治疗方法在不断改进,但是其预后仍然较差。淋巴结转移情况是影响预后的因素之一,本研究旨在探讨胸段食管鳞癌孤立淋巴结跳跃转移的分布情况以及淋巴结跳跃转移对食管鳞癌预后的影响。方法回顾性分析2009-01-01-2013-12-31就诊于山东大学附属山东省肿瘤医院的62例手术切除的胸段食管鳞癌患者的临床病理资料,建立数据库。选取年龄、性别、肿瘤长度、肿瘤部位、T分期、分化程度、清除淋巴结数、术后治疗方法等临床特征因素,应用寿命表法计算患者术后总的1、3、5年生存率,用Kaplan-Meier法计算患者累积生存率,并绘出生存曲线,组间比较用Log-Rank检验,多因素分析采用Cox模型分析。统计分析采用SPSS 17.0软件包进行分析。结果全组患者有淋巴结跳跃转移31例,转移率为50.0%。其中中段及下段发生跳跃转移数分别为26例（83.9%）和5例（16.1%）。生存分析显示全组中位生存时间和5年生存率为43.7个月和26.0%。伴随跳跃转移者中位生存时间及5年生存率为33.6个月和16.0%,无跳跃转移中位生存时间及5年生存率为51.9个月和35.0%,P=0.036。单因素分析发现,淋巴结跳跃转移（P=0.005）和术后治疗方式（P=0.037）影响预后;多因素分析表明,淋巴结跳跃转移（P=0.039,HR=1.793,95%CI：1.031～3.120）是预后的独立影响因素。结论跳跃转移在胸段食管癌中常见,淋巴结跳跃转移是食管鳞癌患者预后的危险因素。

OBJECTIVE Although the treatment of esophageal squamous cell carcinoma（ESCC）has been improved in recent years,the prognosis is still poor.Lymph node metastasis is an important factor for predicting the prognosis of patients with ESCC,the purpose of this study was to investigate the incidence of nodal skip metastasis（NSM）and assess the prognostic value of NSM in patients with thoracic esophageal squamous cell carcinoma.METHODS Between January1,2009 and December 31,2013,62 patients who underwent complete resection with solitary lymph node metastasis were enrolled.For the entire group,NSM occurred in 50.0%（31/62）patients.The survival rate was calculated using life table method and compared between groups by Log-Rank test,survival curve was drawn by using Kaplan-Meier method,Cox model was used for multiple factor analysis.All statistical tests were performed with SPSS 17.0software（SPSS,Chicago,IL）.RESULTS There were 50%（31/62）of patients with lymph node skip metastasis.Meier analysis showed that lymph node skip metastasis（P=0.005）and adjuvant therapy（P=0.037）influenced prognosis.Cox model analysis showed that NSM（P=0.039,HR：1.793,95%CI：1.031-3.120）was independent prognostic factor.CONCLUSION It concluded that NSM was common in ESCC and associated with negative survival.