SiewertⅡ型食管胃结合部腺癌No.5、No.6淋巴结转移特点及清扫意义

Characteristics of lymph node(No.5 and No.6)metastasis and significance of lymph node dissection in Siewert typeⅡesophagogastric junction adenocarcinoma(AEG)

目的分析SiewertⅡ型食管胃结合部腺癌(adenocarcinoma of esophagogastric junction,AEG)No.5、No.6组淋巴结转移的特点、相关危险因素及预后影响。方法收集2013年1月至2016年3月在皖南医学院弋矶山医院完成全胃切除+D 2淋巴结清扫的SiewertⅡ型AEG病例(均达到胃癌D 2根治标准),统计病人基本资料(性别、年龄)及标本的病理特征(肿瘤最大直径、位置、侵犯深度、分化程度、神经及脉管侵犯情况等),计算No.5、No.6组淋巴结转移率,采用IBM SPSS统计学软件,分析影响No.5、No.6组淋巴结转移的相关危险因素。采用Kaplan-M法进行生存分析,生存率比较采用Log-rank检验。结果SiewertⅡ型AEG病人142例,No.5组淋巴结阳性率为10.81%(8/74),No.6组淋巴结阳性率为8.33%(11/132)。病人No.5、No.6组淋巴结转移与未转移者在性别、年龄、肿瘤最大直径、肿瘤位置(贲门左/贲门右)方面差异均无统计学意义(均P>0.05),而病人No.5、No.6组淋巴结转移与未转移者在肿瘤的侵犯深度、分化程度、神经及脉管侵犯方面差异均有统计学意义(均P<0.05)。No.5淋巴结阳性组3年生存率为25.0%,No.5淋巴结阴性组3年生存率为57.8%,两者差异有统计学意义(P<0.05)。No.6淋巴结阳性组3年生存率为18.2%,No.6淋巴结阴性组3年生存率为53.8%,两者差异有统计学意义(P<0.05)。结论对于SiewertⅡ型AEG,当肿瘤侵犯胃壁全层、低分化、脉管神经侵犯时,No.5、No.6组淋巴结转移率较高,3年生存率低,可能全胃切除+D 2淋巴结清扫手术方式更适宜。

Objective To analyze the characteristics,related risk factors and prognosis of lymph node metastasis(No.5 and No.6)in the group of adenocarcinoma of esophagogastric junction(AEG).Methods The patients with SiewertⅡAEG who underwent total gastrectomy and D2 lymph node dissection from January 2013 to March 2016 in Yijishan Hospital of Wannan Medical University were enrolled in this study.The pathological features of the postoperative specimens were analyzed(sex,age,maximum diameter,location,depth of invasion,degree of differentiation,neurological and vascular invasion,etc.),and the lymph node metastasis rate of No.5,No.6 groups were calculated.The analysis was performed by IBM SPSS statistical software.The risk factors associated with lymph node metastasis in No.5 and No.6 groups were analyzed.Survival analysis was performed by Kaplan-M method,and survival rate was estimated.Log-rank test was used for comparison,and the difference was statistically significant at P<0.05.Results There were 142 cases of Siewert type II AEG with the positive rate of No.5 lymph nodes being 10.81%(8/74),and the positive rate of No.6 lymph nodes was 8.33%(11/132).No.5 and No.6 lymph nodes metastasis were not associated with gender,age,tumor maximum diameter,location(cardiac left/cardiac right)(P>0.05),and were associated with invasion depth,differentiation degree,nerve and vascular invasion(P<0.05).In the No.5 lymph node-positive group,the 3-year OS was 25.0%,and the No.5 lynph node-negative group had a 5-year OS of 57.8%,which was statistically different(P<0.05).TThe 3-year OS was 18.2%in No.6 node-positive group and 53.8%in No.6 node-negative group,and the difference was statistically significant(P<0.05).Conclusion For Siewert typeⅡAEG,the lymph node metastasis rate was higher in No.5 and No.6 groups when the tumor invaded all layers of gastric wall and was poorly differentiated complicated with vascular nerve invasion,and the lymph node metastasis rate was lower at 3 years,which may be more appropriate for total gastrectomy+D2 lymph node dissection.