食管区及胃区淋巴管浸润对食管胃交界部腺癌患者的预后评估价值

Prognostic Value of Lymphatic Invasion in Esophageal and Gastric Regions in Patients with Adenocarcinoma of Esophagogastric Junction

[目的]探讨食管胃交界部腺癌(AEG)患者食管区淋巴管浸润(ELI)和胃区淋巴管浸润(GLI)的发生率及临床意义。[方法]回顾性分析134例行根治性手术的AEG患者的临床病理资料,采用免疫组化法检测ELI和GLI阳性率,分析两者对纵隔淋巴结转移及患者预后的影响。[结果](1)Siewert I型、Ⅱ型和Ⅲ型AEG患者分别有28例、76例和30例。ELI阳性率为34.3%(46/134),GLI阳性率为50.0%(67/134)。多因素分析显示,ELI阳性和食管侵犯长度>30mm是影响纵隔淋巴结转移的独立危险因素(P均<0.05)。(2)全组患者中位随访时间49个月,Log-rank检验显示,ELI(-)患者5年总生存率(OS)明显好于ELI(+)患者(χ^(2)=6.782,P<0.001),虽然GLI(-)患者的长期生存结果也好于GLI(+)患者,但差异无统计学意义(χ^(2)=1.423,P=0.061)。多因素分析显示,食管侵犯长度>30mm、≥T2分期、ELI阳性是影响预后的独立危险因素(P<0.05)。[结论] ELI阳性与纵隔淋巴结转移与患者预后密切相关,与GLI相比,ELI状态评估可能更具临床价值。

[Objective] To investigate the incidence of lymphatic invasion in the esophagus(ELI) and lymphatic invasion in gastric region(GLI) and its significance in patients with esophageal gastric junction adenocarcinoma(AEG). [Methods] The clinicopathological data of 134 patients with AEG undergoing radical operation were retrospectively analyzed. The positive rates of ELI and GLI were detected by immunohistochemical method,and the effects of them on mediastinal lymph node metastasis and prognosis were analyzed. [Results](1)The number of Siewert type Ⅰ, Ⅱand Ⅲ patients were 28,76 and30,respectively. The total positive rate of ELI and GLI was 34.3%(46/134) and(67/134).The positive ELI and the length of esophageal invasion>30 mm were independent risk factors for mediastinal lymph node metastasis(P<0.05). Multivariate analysis showed that positive ELI and esophageal invasion length>30 mm were independent risk factors for mediastinal lymph node metastasis(P <0.05).(2)The median follow-up time was 49 months. Log-rank test showed that the 5-year overall survival(OS) of patients with ELI(-) was significantly better than that of patients with ELI(+)(χ^(2)=6.782,P<0.001). Although the longterm survival of patients with GLI(-) was better than that of patients with GLI(+),but the difference was not statistically significant(χ^(2)=1.423,P=0.061). Multivariate analysis showed that esophageal invasion length >30 mm,≥T2 stage and positive ELI were independent risk factors for prognosis(P<0.05).[Conclusion] The positive expression of Eli was closely related to mediastinal lymph node metastasis and prognosis.Compared with GLI,the assessment of ELI status may have more clinical value.