基于中国专家共识分组的食管癌淋巴结1061例清扫疗效的单中心回顾性研究

Effectiveness of lymphadenectomy of 1061 patients based on the grouping of esophageal cancer lymph nodes by Chinese expert consensus: A retrospective analysis in a single center

目的按照中国专家共识的淋巴结分组,评估不同位置食管鳞状细胞癌(鳞癌)的各区域淋巴结清扫效果。方法回顾性分析2011年3月—2017年12月华中科技大学同济医学院附属同济医院收治的食管恶性肿瘤1061例患者的临床资料,其中男886例、女175例,中位年龄60(54,65)岁。依据病理报告,按照食管癌淋巴结中国分组标准重新分组,计算每一组淋巴结的转移率、转移患者的5年生存率及治疗指数(efficacy index,EI)。结果胸上段食管肿瘤主要转移至C201~203组淋巴结。胸中、下段食管肿瘤主要转移至C205~207组淋巴结。胸下段食管肿瘤的腹腔淋巴结转移率较高。依据转移率,纵隔淋巴结被分为上纵隔(C201~204)、中纵隔(C205~206)和下纵隔(C207~209)三个区域。C201~203、C205~207组淋巴结的EI较高。在C201~207组中,各组淋巴结转移患者的5年生存率为13.39%~21.60%。对于各区域淋巴结阳性患者,不同原发位置肿瘤的远期生存率差异无统计学意义(P>0.05)。C205组淋巴结在胸上段癌中EI低而在胸中、下段肿瘤中较高。结论每个区域淋巴结清扫效果因肿瘤部位不同而不同。不论肿瘤处于何位置,上纵隔淋巴结,特别是左、右侧喉返神经旁淋巴结的清扫都是必要的。C205组应被划入下纵隔淋巴结。

Objective To assess the efficacy of lymphadenectomy in different regions for esophageal squamous cell carcinomas located differently according to the lymph node grouping by Chinese expert consensus.Methods The medical records of 1061 patients(886 males and 175 females with a median age of 60(54,65)years with esophageal cancer from March 2011 to December 2017 in our hospital were retrospectively analyzed.According to the pathological report,the lymph nodes were regrouped according to the Chinese lymph nodes grouping standard of esophageal cancer.The metastasis rate of each group of lymph nodes,the 5-year survival rate of metastatic patients and efficacy index(EI)were calculated.Results The upper thoracic esophageal cancer mainly metastasized to the lymph nodes of C201-203 groups.The middle and lower thoracic tumors mainly metastasized to the lymph nodes of C205-207 groups.The lower thoracic tumor had a higher rate of metastasis to the abdominal lymph nodes.According to the metastasis rate,the mediastinal lymph nodes were divided into three regions:an upper mediastinum(C201-204),a middle mediastinum(C205-206),and a lower mediastinum(C207-209).The EIs of lymph nodes of C201-203 and C205-207 groups were higher.For patients with C201-207 groups metastasis,the 5-year survival rates ranged from 13.39%to 21.60%.For patients with positive lymph nodes in each region,tumors at different primary locations had no statistical difference in long-term survival(P>0.05).Patients with lymph nodes of C205 group in the upper thoracic tumors had lower EI and those in the middle and lower thoracic tumors had higher EIs.Conclusion The effect of lymph node dissection in each area varies with the location of the tumor.No matter where the tumor is,it is necessary to dissect the upper mediastinal lymph nodes,especially the lymph nodes adjacent to the left and right recurrent laryngeal nerves.Group C205 should be classified into the lower mediastinal lymph nodes.