T1期食管癌淋巴结转移的预后因素分析

Lymph node metastasis and prognostic factors for T1 esophageal cancer

目的 探讨T1期食管癌淋巴结转移的预后因素.方法 收集2011年1月至2016年7月于天津医科大学肿瘤医院食管肿瘤科行食管癌切除和淋巴结清扫术的143例pT1期食管癌患者的临床病理资料.男性120例,女性23例;年龄44 ～ 77岁,中位年龄60岁;T1a期50例,T1b期93例.收集患者的淋巴结转移情况,应用Logistic回归模型确立其预后因素.结果 143例T1期食管癌患者中,25例发生淋巴结转移,淋巴结转移率为17.5％;T1a期淋巴结转移率为16.0％ （8/50）,T1b期淋巴结转移率为22.6％ （21/93）.T1期食管癌发生颈部淋巴结转移1例,胸部淋巴结转移15例,腹部淋巴结转移17例;跳跃性转移18例,沿食管纵轴双向转移6例;双侧喉返神经旁淋巴结转移8例,胃左动脉旁淋巴结转移8例,贲门旁淋巴结转移6例,食管旁淋巴结转移5例.Logistic回归分析结果显示,肿瘤浸润深度（OR=4.641,95％ CI：1.279～ 16.836,P=0.020）、肿瘤最大径（OR=5.301,95％ CI：1.779～ 15.792,P=0.003）、肿瘤位置（OR=3.238,95％ CI：1.248～8.401,P=0.016）和分化程度（OR=5.301,95％ CI：1.719～ 16.347,P=0.004）是T1期食管癌淋巴结转移的独立预后因素,肿瘤最大径（OR=4.117,95％ CI：1.228～ 13.806,P=0.022）是胸部淋巴结转移的独立预后因素,脉管瘤栓（OR=6.058,95％ CI：1.228～29.876,P=0.027）和肿瘤位置（OR=8.113,95％ CI：1.785～36.872,P=0.007）是腹部淋巴结转移的独立预后因素.结论 T1期食管癌具有较高的淋巴结转移率,与肿瘤浸润深度、肿瘤最大径、肿瘤位置和组织学分化有关.术前应评估T1期食管癌淋巴结转移风险和转移部位,制定最佳手术方案和淋巴结清扫策略.

Objective To evaluate the lymph node metastasis （LNM） pattern and related prognostic factors for T1 esophageal cancer.Methods Clinical data of 143 cases of pT1 esophageal cancer patients （120 male and 23 female patients with median age of 60 years） who underwent esophagectomy and lymph node resection during January 2011 and July 2016 at the Department of Esophageal Cancer of Tianjin Medical University Cancer Institute and Hospital were reviewed,including 50 cases of T1a patients and 93 cases of T1b patients.The LNM pattern was analyzed and the prognostic factors related to LNM were assessed by x2 test and Logistic regression analysis.Results Of 143 patients,25 patients had LNM.The LNM rates were 17.5% for pT1 tumors,16.0% （8/50） for pT1a tumors,and 22.6% （21/93） for T1b tumors.Of 25 patients with LNM,one patient had cervical metastasis,15 patients with thoracic metastasis,and 17 patients with abdominal metastasis.The relatively highest LNM sites were laryngeal recurrent nerve （8 cases）,left gastric artery （8 cases）,right and left cardiac （6 cases） and thoracic paraesophageal （5 cases）.Logistic regression analysis showed that the depth of tumor infiltration （OR =4.641,95% CI：1.279 to 16.836,P=0.020）,tumor size （OR =5.301,95% CI：1.779 to 15.792,P =0.003）,tumor location （OR=3.238,95% CI：1.248 to 8.401,P =0.016）,and tumor differentiation （OR =5.301,95%CI：1.719 to 16.347,P=0.004） were independent prognostic factors related to LNM for T1 esophageal cancer.Tumor size （OR=4.117,95% CI：1.228 to 13.806,P=0.022） was an independent risk factor related to thoracic LNM,and the vessel invasion （OR =6.058,95% CI：1.228 to 29.876,P =0.027） and tumor location （OR =8.113,95% CI：1.785-36.872,P =0.007） were independent prognostic factors related to abdominal LNM.Conclusions T1 esophageal cancer has a relatively high LNM rate,and the depth of tumor infiltration,tumor size,tumor location and tumor differentiation are correlated with LNM.The LNM risk and extent must be considered comprehensively in decision-making of a better surgical treatment and lymph node resection strategy.