【作者】 王春利； 张双平； 韩小友； 王晓军； 游志恒； 郭粽亮；

【Author】 Wang Chun-Li Zhang Shuang-Ping Han Xiao-You Wang Xiao-Jun You Zhi-Heng Guo Zong-Liang The 2nd Department of Thoracic Surgery, Shanxi Cancer Hospital, Taiyuan, 030013, China

【机构】 山西省肿瘤医院；

【摘要】 目的:探讨胸段食管癌转移淋巴结的数量与食管癌的预后关系,以及影响淋巴结转移数量的因素。方法:回顾性分析1996年10月-2000年8月在山西省肿瘤医院行胸段食管癌根治术后患者282例。所得结果采用SPSS13．0软件包进行生存分析分析。结果:1．淋巴结转移数量与食管癌的生存率负相关(P=0．000);以每例淋巴结转移数分为0、1-3、>3枚 3组进行比较,其结果各组1．3．5年生存率组间差别有统计学意义(P<0．05)。2．本组病例淋巴结切除数量与淋巴结转移度成正相关(P<0．05);淋巴结转移度、淋巴结转移部位及与食管癌的预后无统计学意义关系(P>0．05),4．淋巴结转移数量与癌的组织分化、癌组织的长度、周径及淋巴管内是否有癌栓相关性,且具有统计学意义(P<0．05)。结论:1．食管癌有淋巴结转移的1、3、5年生存率及中位生存期明显低于无淋巴结转移者。2．食管癌手术时切除淋巴结数越多,淋巴结转移数量越多,提示术中应注重系统清扫淋巴结。3．本研究提示食管癌淋巴结转移数量与该病预后有重要关系,能反映其预后,建议pTNM分期将淋巴结转移数考虑在内。4．淋巴结转移的数量与癌组织的分化、肿瘤的大小及其周径以及淋巴管内是否有癌栓有关,其中有癌栓是无癌栓的8．79倍。5．本组样本小,尚需继续积累资料,进一步研究观察。更多还原

【Abstract】 Objective: The author explored the effect of number of positive lymph nodes on survival in patients with esophageal carcinoma. And to evaluate influence factors of number of positive lymph nodes. Methods: During October 1996 to August 2000, a total of 2,807 resected lymph nodes were obtained from 282 patients who underwent curative resection of the primary tumour with systematic lymphadenectomy at the Shanxi cancer hospital, China.The survivals were analysed by life tables and Kaplan-Meier methods,the related factors of lymph node metastasis were assessed by Chi-square test. Results: (1) The 1- year, 3- year, and 5-year survival for node-negative patients was 80.65%, 50.12%, 36.70%versus 6535%, 22.46%, 7.94% for node-positive patients (P =0.0000). (2) The number of positive lymph nodes was negative related to survival rates in carcinoma of thoracic esophageal. According to the number of positive lymph node metastasis, there was significant difference in survival among our suggesting grouping: node-negative, one to six nodes and more than 3 nodes. (3) The number of positive lymph nodes was positive related to metastatic lymph node ratio, Metastatic lymph node ratio, location of metastatic lymph node were not associated with survival rates in carcinoma of thoracic esophageal (4) The risk of the number of positive lymph node metastasis as significantly influenced by length 、his-tologic grade 、circumference and lymphangial tumor-cells thrombus (x 2 =40.559 P =0.034, x 2= 29.919 P = 0.000, x 2 =52.796 P =0.035, x 2 =5.842 P =0.016, respectively). Conclusion: (1) The number of positive lymph nodes involvement was the most important prognostic factor in both classifications (2) The more lymph nodes were resected, the more positive lymph nodes were found. (3) The number of positive lymph node can better reflect the prognosis of patients. The authors suggest modification of the tumor-lymph node-metastasis (TNM) staging classification (ypTNM) be addict to the number of positive lymph nodes in the ypNl category. (4)The risk of the number of positive lymph node metastasis as significantly influenced by length 、histologic grade 、circumference and lymphangial tumor-cells thrombus relative risk with respect to positive 8.79 for negative. (5) It should be confirmed by a bigger sample amount and multicentral study.更多还原