N1期胸段食管鳞状细胞癌淋巴结转移规律及预后分析

Analysis of lymph node metastasis and prognosis of stage N1 thoracic esophageal squamous cell carcinoma

目的探讨N1期胸段食管鳞状细胞癌(鳞癌)淋巴结转移规律及其与预后的关系。方法回顾性分析2015—2017年于中国科学技术大学附属第一医院行食管癌根治术且术后病理诊断为N1期(1~2枚淋巴结转移)的121例患者的临床及随访资料,其中男104例(86.0%)、女17例(14.0%),平均年龄(64.9±8.3)岁。结果左上气管旁淋巴结、右上气管旁淋巴结、下段食管旁淋巴结、贲门旁淋巴结、胃小弯和胃大弯淋巴结的早期转移率较高,分别为22.6%、28.0%、21.2%、41.7%、25.0%和25.0%。左上气管旁淋巴结转移组与未转移组3年生存率分别为8.3%、34.9%,差异有统计学意义(P=0.000);隆突下淋巴结转移组与未转移组3年生存率分别为10.5%、36.3%,差异有统计学意义(P=0.032)。多因素Cox回归分析结果显示,左上气管旁淋巴结转移(P=0.000)、隆突下淋巴结转移(P=0.010)是食管鳞癌早期淋巴结转移患者的独立预后因素。单纯腹部淋巴结转移组与单纯胸部淋巴结转移组3年生存率分别为51.1%、25.0%,差异有统计学意义(P=0.016)。结论N1期胸段食管鳞癌淋巴结易转移至左上气管旁淋巴结、右上气管旁淋巴结、下段食管旁淋巴结、贲门旁淋巴结、胃小弯和胃大弯淋巴结;左上气管旁淋巴结转移、隆突下淋巴结转移是N1期患者的独立预后因素;N1期患者单纯腹部淋巴结转移较单纯胸部淋巴结转移患者预后好。

Objective To investigate the rule of lymph node metastasis and its relationship with prognosis in stage N1 thoracic esophageal squamous cell carcinoma.Methods The clinical and follow-up data of 121 stage N1(1 to 2 lymph node metastases)thoracic esophageal squamous cell carcinoma patients,who underwent radical resection of esophageal carcinoma in our hospital from 2015 to 2017,were retrospectively analyzed.There were 104(86.0%)males and 17(14.0%)females with an average age of 64.9±8.3 years.Results The early metastasis rates of the left upper paratracheal,right upper paratracheal,lower thoracic paraesophageal,paracardial,lesser curvature and greater curvature lymph nodes were 22.6%,28.0%,21.2%,41.7%,25.0%and 25.0%,respectively.The three-year survival rates in the group with and without left upper paratracheal lymph node metastasis were 8.3%and 34.9%,respectively(P=0.000).The threeyear survival rates of the subcarinal lymph node metastasis group and the non-metastasis group were 10.5%and 36.3%,respectively(P=0.032).Multivariate Cox regression analysis showed that,left upper paratracheal lymph node metastasis(P=0.000)and subcarinal lymph node metastasis(P=0.010)were independent prognostic factors for early stage lymph node metastasis of esophageal squamous cell carcinoma.The three-year survival rates of patients with simple abdominal lymph node metastasis and those with simple thoracic lymph node metastasis were 51.1%and 25.0%,respectively(P=0.016).Conclusion The lymph nodes of N1 stage thoracic esophageal squamous cell carcinoma are more likely to metastasize to left upper paratracheal lymph nodes,right upper paratracheal lymph nodes,lower thoracic paraesophageal lymph nodes,paracardial lymph nodes,lesser curvature of stomach and greater curvature of stomach lymph nodes.Lymph node metastases of left upper paratracheal and subcarinal are independent factors for the prognosis of patients with stage N1 thoracic esophageal squamous cell carcinoma.The prognosis of patients with simple abdominal lymph node metastasis is better than that of patients with simple thoracic lymph node metastasis.