微创食管癌切除术后淋巴结转移规律及预后分析

Clinicopathological features of lymph node metastasis and prognostic factors in esophageal cancer treated with minimally invasive esophagectomy

目的淋巴结转移是食管癌转移的主要方式,对食管癌患者预后有重要影响,本文探讨食管癌胸腹二区淋巴结的转移规律。方法选取2010年1月至2016年10月于山东大学齐鲁医院经微创食管癌切除术(minimally invasive esophagectomy,MIE)治疗的食管癌患者613例,参照日本食管肿瘤研究会(JEOG)淋巴结分区标准清扫淋巴结,统计各组淋巴结的转移率。对2010年1月至2013年10月行MIE治疗的203例食管癌患者进行生存分析。另外410例患者由于术后时间较短,随访数据未列入统计。结果胸上段食管癌较多发生上纵隔淋巴结转移,其左、右喉返神经旁淋巴结转移率分别高达35.9%、40.7%,均显著高于胸中段和胸下段食管癌;胸中段食管癌既向上发生上纵隔淋巴结转移,又向下发生腹腔淋巴结转移;胸下段食管癌主要向胃周淋巴结转移,其中胃左动脉旁淋巴结转移率最高。单因素分析结果显示,病变长度、肿瘤分化程度、肿瘤浸润深度、淋巴结转移程度是影响食管癌患者预后的相关因素(P<0.05)。COX多因素回归分析结果显示,肿瘤低分化和淋巴结转移是影响食管癌患者预后不良的独立危险因素(P<0.05)。结论手术治疗食管癌应重点清扫双侧喉返神经旁淋巴结和胃左动脉旁淋巴结。

Objective The role of lymph node is vital in the prognosis of esophageal carcinoma. This study is to explore the pattern of thoraco-abdominal two-field lymphatic metastasis. Methods 613 patients with esophageal carcinoma visiting Qilu Hospital of Shandong University from Jan. 2010 to Oct. 2016 were included in this study. The lymph node metastasis rate of each group was counted according to the standard of lymph node division of the Japan Esophageal Cancer Research Association（JEOG）. Survival analysis was performed in 203 patients from Jan. 2010 to Oct. 2013. Results Carcinoma of the upper thoracic esophagus mainly metastasized to mediastinal lymph nodes. The rates of metastasis to the left and right recurrent nerve lymph nodes were 35. 9% and 40. 7%,which were higher than that of middle-third and lower third of esophageal carcinoma. Carcinoma of the middle-third thoracic esophagus metastasized bidirectionally; and carcinoma of the lower-third thoracic esophagus mainly metastasized to the lymph nodes of the para-esophagus,lateral cardia and left gastric artery,among which the metastasis rate of left gastric artery was the highest.Univariate survival analysis showed that the lesion length,the degree of tumor differentiation,the depth of tumor invasion and lymph node metastasis were prognostic factors of esophageal carcinoma patients（P〈0. 05）. Multivariate analysis by COX regression showed that the low degree of tumor differentiation and status of lymph node metastasis were independent risk factors affecting the prognosis of esophageal carcinoma（P〈0. 05）. Conclusions Thus,it was important to clear the lymph nodes of the bilateral recurrent laryngeal nerve and left gastric artery to improve the survival rate of patients with thoracic esophageal carcinoma.