【摘要】 背景与目的:目前,食管癌术中对淋巴结清扫范围尚有争议。本研究通过了解胸段食管癌淋巴结转移规律及其对预后的影响,探讨合理的淋巴结清扫范围。方法:对217例经“三野”淋巴结清除根治术的食管癌患者的临床资料进行回顾性分析。选择9个可能对食管癌切除术后预后产生影响的特征性临床病理因素,通过计算机Cox比例风险模型进行预后分析。结果:全组淋巴结清除术后1、3、5年生存率分别为82.6%、59.8%、和48.8%。淋巴结转移率62.6%,转移度11.38%,淋巴结“跳跃性转移”率为5.5%。胸上、中、下段食管癌颈部、胸部纵隔和腹腔淋巴结转移率分别达到31.7%、21.9%、9.75%,21.2%、30.5%、12.7%和12.1%、15.6%、34.5%。影响淋巴结转移的主要因素为肿瘤浸润深度、分化程度及有无淋巴管浸润;肿瘤长度则影响不大。多因素分析表明,肿瘤浸润深度、分化程度、淋巴结转移区域数和肿瘤部位对预后的影响有显著性意义。随着食管癌淋巴结转移区域数的增加,患者生存率逐渐下降(P=0.0284)。结论:淋巴结转移尤其是淋巴结转移区域数是胸段食管癌预后的主要因素。胸段食管癌表现出上下“双向性”转移和跳跃性转移的特点,应常规行“三野”淋巴结清扫术,以提高患者5年生存率。更多还原

【Abstract】 BACKGROUND &OBJECTIVE :At present,the rang e of lymph node dissection in treatment of thor acic esophag eal cancer is still cont roversial.This study was desig ned to explore th e status of lymph node metastases of thoracic esophag eal carcinoma and i ts influence on the prog nosis and to s eek reasonable dissecting rang e of lymp h nodes .METHODS :A retrospective study was performed on the clinical d ata of 217patients who had underwent radical operation throug h three-field lymphadenectomy.Nine disting uishing clinicopatholog ical factors possi bly influencing survival rate were c hosen.A multivariate analysis of these fact ors was performed by the computerize d Cox proportional hazards model.RESULTS :The 1-,3-,and 5-year survival rates of all patients were 82.6%,59.8%,and 48.8%,respectively.The lymph node metastasis rate was 62.6%and the leaping metastasis rate of lymph nodes was 5.5%.In 3989lymph nodes dissect ed ,metastases were detected in454(11.38%).The lymph node metastasis rates pre sent in neck,thoracic mediastinum,and abdominal cavity w ere 31.7%,21.2%,and 12.1%in upper-thoracic esophag eal carcinoma,21.9%,30.5%,and 15.6%in middle-thoracic carcinoma,9.75%,12.7%,and 34.5%in lower-thoracic carcinoma,respectively.Deg ree of tumor differentiation,depth of tum or invasion,and lymphatic vessels invasion were the factors influencing l ymph nodes metastases ,but the leng th of t umor was not.According to multivariate analysis,depth of tumor invasion,t umor differentiation,the number of lymph nodes metastatic field,and tumor lo cation were of prog nostic sig nificance.With the increasing of the number of lymph nodes metastatic field,the surviva l rate of the patients dropped g radually(P=0.0284).CONCLUSION:Lymph node metastasis especially the number of lymph node metastatic field is one of key factors affecting the prog nosis of patients.Because of the upward,down ward,and leaping spreading of esophag eal carcinoma cells to the lymph nodes ,t he patients with thoracic esophag eal c arcinoma should be g iven radical ope ration throug h three-field lymphadenecto my to promote the 5-years survival ra te.更多还原