胸段食管鳞状细胞癌右喉返神经旁淋巴结转移特点

Characteristics of lymph node metastasis of right recurrent laryngeal nerve in thoracic esophageal squamous cell carcinoma

目的分析胸段食管鳞状细胞癌(鳞癌)右喉返神经旁淋巴结转移特点及其影响因素,探讨合理的淋巴结清扫范围及右喉返神经旁淋巴结清扫的价值。方法回顾性分析2015—2018年于中国医学科学院肿瘤医院行右胸入路食管癌根治术+胸腹二野淋巴结清扫或颈胸腹三野淋巴结清扫术的胸段食管鳞癌患者的临床病理资料,影响因素分析采用logistic回归分析。结果516例患者中,发生右喉返神经旁淋巴结转移80例,转移率为15.5%。全组患者共清扫右侧喉返神经旁淋巴结1127枚,115枚淋巴结存在转移,淋巴结转移度为10.2%。T分期、肿瘤分化程度和肿瘤位置与右喉返神经旁淋巴结转移有关(均P<0.05)。胸上段食管鳞癌右喉返神经旁淋巴结转移率(23.4%,26/111)高于胸中段、胸下段鳞癌[分别为13.5%(40/296)和12.8%(14/109)],低分化食管鳞癌患者右喉返神经旁淋巴结转移率[20.6%(37/180)]高于中、高分化食管鳞癌患者[分别为14.6%(39/267)和5.8%(4/69)]。T4期食管鳞癌患者右喉返神经旁淋巴结转移率[27.3%(3/11)]高于T1、T2、T3期食管鳞癌患者[分别为9.6%(19/198)、19.0%(16/84)和18.8%(42/223)]。多因素回归分析显示,肿瘤位置(OR=0.61,95%CI:0.41~0.90,P=0.013)、肿瘤浸润深度(OR=1.46,95%CI:1.11~1.92,P=0.007)、肿瘤分化程度(OR=1.67,95%CI:1.13~2.49,P=0.011)为食管鳞癌右侧喉返神经旁淋巴结转移的独立危险因素。结论右侧喉返神经旁淋巴结转移率较高,应作为食管鳞癌手术常规清扫部位。肿瘤位置、肿瘤浸润深度、肿瘤分化程度是食管鳞癌右侧喉返神经旁淋巴结转移的危险因素。

Objective To understand the characteristics and influencing factors of lymph node metastasis of the right recurrent laryngeal nerve in thoracic esophageal squamous cell carcinoma(ESCC),and to explore the reasonable range of lymph node dissection and the value of right recurrent laryngeal nerve lymph node dissection.Methods The clinicopathological data with thoracic ESCC were retrospectively analyzed,and the characteristics of lymph node metastasis along the right recurrent laryngeal nerve and its influencing factors were explored.Results Eighty out of 516 patients had lymph node metastasis along the right recurrent laryngeal nerve,the metastasis rate was 15.5%.Among 80 patients with lymph node metastasis along the right recurrent laryngeal nerve,25 cases had isolated metastasis to the right recurrent laryngeal nerve lymph node but no other lymph nodes.The incidence of isolated metastasis to the recurrent laryngeal nerve lymph node was 4.8%(25/516).A total of 1127 lymph nodes along the right recurrent laryngeal nerve were dissected,115 lymph nodes had metastasis,and the degree of lymph node metastasis was 10.2%.T stage,degree of tumor differentiation and tumor location were associated with right paraglottic nerve lymph node metastasis(all P<0.05).The lymph node metastasis rate along the right recurrent laryngeal in patients with upper thoracic squamous cell carcinoma(23.4%,26/111)was higher than that of patients with middle(13.5%,40/296)and lower(12.8%,14/109)thoracic squamous cell carcinoma(P=0.033).In patients with poorly differentiated ESCC(20.6%,37/180)the metastasis rate was higher than that of patients with moderately(14.6%,39/267)and well-differentiated(5.8%,4/69;P<0.05).The lymph node metastasis rate of patients with stage T4(27.3%,3/11)was higher than that of patients with stage T1(9.6%,19/198),T2(19.0%,16/84)and T3(18.8%,42/1223;P<0.05).Multivariate regression analysis showed that tumor location(OR=0.61,95%CI:0.41-0.90,P=0.013),invasion depth(OR=1.46,95%CI:1.11-1.92,P=0.007),and differentiation degree(OR=1.67,95%CI:1.13-2.49,P=0.011)were independent risk factors for lymph node metastasis along right recurrent laryngeal nerve of ESCC.Conclusions The lymph node along the right recurrent laryngeal nerve has a higher rate of metastasis and should be routinely dissected in patients with ESCC.Tumor location,tumor invasion depth,and differentiation degree are risk factors for lymph node metastasis along right recurrent laryngeal nerve in patients with ESCC.