食管癌喉返神经旁淋巴结预测锁骨上淋巴结转移的临床分析

Clinical analysis of the predictive value of recurrent laryngeal nerve lymph nodes status for supraclavicular lymph node metastasis in esophageal squamous cell carcinoma

目的探讨食管鳞状细胞癌患者喉返神经旁淋巴结(recurrent laryngeal nerve lymph node,RLN)预测锁骨上淋巴结(supraclavicular lymph node,SLN)转移的临床价值。方法回顾性分析2017年1月至2018年4月河南省安阳市肿瘤医院胸外科收治的83例食管鳞状细胞癌患者的临床资料,其中男53例、女30例,年龄(64.07±7.05)岁。结果SLN转移率为24.1%(20/83),胸腹部淋巴结转移组(N1~3)和未转移组(N0)的SLN转移率分别为37.8%(14/37)、13.0%(6/46),差异有统计学意义(P=0.009)。亚组分析,RLN转移阳性组和阴性组SLN转移率分别为39.1%(9/23)和18.3%(11/60),差异有统计学意义(P=0.047)。单侧RLN转移阳性均可导致对侧SLN转移。年龄、性别、肿瘤浸润深度、肿瘤位置、肿瘤分级、肿瘤最大径、T分期、病理分型与SLN转移无相关性(P>0.05)。胸腹部淋巴结转移是SLN转移的独立预测因素(P=0.002)。结论RLN转移阳性不是SLN转移的独立预测因素。任何肿瘤位置、T分期的食管鳞状细胞癌患者出现胸腹部淋巴结转移时均应行SLN清扫,即使单侧RLN阳性也应行双侧锁骨上淋巴结清扫。

Objective To investigate the predictive value of recurrent laryngeal nerve lymph nodes(RLN)status for supraclavicular lymph node(SLN)metastasis in esophageal squamous cell carcinoma.Methods We retrospectively analyzed the clinical data of 83 patients with esophageal squamous cell carcinoma who underwent McKeown three-field lymphadenectomy from January 2017 to April 2018 in our hospital,including 53 males and 30 females with an average age of 64.07±7.05 years.Results The SLN metastasis rate of the patients was 24.1%.The rate in the thoracic and abdominal metastases positive(N1-3)group and negative(N0)group was 37.8%and 13.0%,respectively,with a statistical difference(P<0.05).The rate of SLN metastasis was significantly different between the RLN metastasis positive(RLN+)and negative(RLN-)groups(39.1%vs.18.3%,P<0.05).One side of RLN metastasis could lead to SLN metastasis on the opposite side.No correlation between the SLN metastasis and age,gender,location,differentiation degree,maximum tumor diameter,T-staging or histologic type was observed(P>0.05).Multivariate analysis showed that lymph node metastasis in chest or abdomen was an independent predictor of SLN metastasis.Conclusion RLN+is not the independent predictor for SLN metastasis.SLN should be dissected in N1-3 patients with esophageal squamous cell carcinoma without considering tumor location and T-staging.Bilateral SLN dissection should be recommended even if RLN metastasis is only unilateral.