【作者】 张合林； 平育敏； 何明； 孟宪利； 白世祥； 杜喜群；

【Author】 Zhang He - Lin Meng Xian - Li He Ming et al. Department of Thoracic Surgery,The Fourth Hospital of Hebei Medical University & Hebei Provincial Tumor Hospital , Shijiazhuang,050011, China

【机构】 河北医科大学第四医院河北省肿瘤医院胸外科；

【摘要】 目的:淋巴结转移数对肿瘤预后的影响越来越受到人们的重视,1997年UICC把淋巴结转移数加入到了第五版的胃癌等TNM分期。虽然有研究者对少数食管癌病例进行了有关淋巴结转移数对预后影响的研究并受到关注,但2002年第六版的国际食管癌TNM分期仍未将淋巴结转移数因素加入其中。为探讨淋巴结转移数对食管癌预后和国际食管癌TNM 分期标准的影响进行本研究。方法:以1146例10年以上的资料完整的胸段食管鳞状细胞癌患者的临床病理和随访调查资料,通过Kaplan-Meier生存曲线法描述生存过程,Log Rank检验判断生存率差异,并对淋巴结转移数对食管癌预后的影响进行评价。本研究着重对受淋巴结转移影响的Ⅱb期、Ⅲ期结合Ⅱa期进行对比分析;以淋巴结转移数分级(0,1和≥2个转移淋巴结)的不同,对Ⅱ、Ⅲ期的食管癌TNM分期标准进行探讨性新分期的研究:Ⅱa期(T2N0M0、T3N0M0)、Ⅱb期(T1N1M0 T2N1(1)M0)、Ⅲa期(T2N1(2)M0和T3N1(1)M0)和Ⅲb期(T3N1(2)M0和T4N_M0)。结果:①1146例食管鳞状细胞癌患者中发生淋巴结转移380例,转移率33．2％(380/1146);共清除淋巴结4270枚,其中转移807枚,总转移度18．9％(807／4270)。②0、1、2、 3和≥4个转移淋巴结的5年生存率分别为59．79％,,33．38％,14．28％,6．96％和2．98％;总的生存率差别有显著性统计学意义(P<0．001);但是,有2、3和≥4个转移淋巴结组间的生存率差别无统计学意义(P=0．1448)。③0、1和>2个转移淋巴结的5年生存率分别为59．79％,,33．38％和9．35％;三组间有显著差异(P<0．001)。④1和≥2个转移淋巴结的T2N1M0 期(T2N2(1)M0和T2N1(2)M0)的5年生存率分别为41．49％和24．12％;1和≥2个转移淋巴结的T3N1M0期(T3N1(1)M0和T3N1(2) M0)的5年生存率分别为31．16％和6．77％;各组间的生存率均有显著差异(P<0．001)。⑤新分法的Ⅱa期、11号机的。Ⅱ b期、Ⅲa期和Ⅲb期的5年生存率分别为57．06％,42．15％,28．57％和8．52％;总的生存率差异、各期之间的生存率差异均有显著性统计学意义(P<0．001)。结论:淋巴结转移数明显影响着食管癌的预后,以0、1和≥2个转移淋巴结分三个级别较为适宜,能够准确地反映淋巴结转移数和预后的关系;不同淋巴结转移数(1和≥2个转移淋巴结)的T2N1M0和T3N1M0 期的组成很离散,并且T2N1M0和T3N1M0期的组成有交叉现象;新的分期标准(0期、Ⅰ期、Ⅱa期、Ⅱb期、Ⅲa期、Ⅲb期和Ⅳ期)能更好地反映食管癌切除术后患者预后的变化;本研究结果为食管癌TNM分期标准提供了修订依据。更多还原

【Abstract】 Objective:To study the influence of the lymph node metastases number on survival of patients and UICC - TNM classification of carcinoma of the esophagus.Methods: To analyses retrospectively the clinical and pathological materials of 1146 patients who had undergone resection of squamous - cell carcinoma of the thoracic esophagus. Survival was analyzed by the Kaplan - Meier method. According to the number of lymph node metastases(1 and 3:2 one positive node), TNM classification of stage Ⅱ and stage Ⅲ was modified: new stage Ⅱ a(T2N0M0 and T3N0M0)、stageⅡb(T1N1M0 and T2N1(1)M0)、stage Ⅲa(T2N1(2)M0 and T3N1(1)M0) and stage Ⅲb(T3N1(2)M0 and T4N_ M0). Results: Lymph node metastases was found in 380 of 1146 treated esophageal cancer patients (33.2%);In 4270 lymph nodes dissected, metastases was detected in 807 (18.9%) .The 5 - year survival rate of the patients with 0,1 and ≥2 positive nodes was 59.79%, 33.38% and 9.35%,respectively;there was statistically significant difference among these three groups.The 5 - year survival rate of the patients in stage T2N1M0 and stage T3N1M0 was significantly higher in one involved node groups than two or more involved nodes groups (41.49% vs.24.12% and 31.16% vs. 6.77%, P <0.001) .The 5 - year survival rate of the patients in modified stage Ⅱa, Ⅱb, Ⅲ a and ib was 57.06%, 42.15%, 28.57% and 8.52% , respectively, and was statistically significant difference among this modified TNM stages. Conclusion: The number of positive lymph nodes significantly influenced survival of the patients with esophageal cancer; and the three grade classification (0,1,≥2 positive nodes) could quite reflect the relation between the numbers of lymph node metastasis and the survival.The modified TNM - classification based on the numbers of lymph node metastasis could better reflect the prognosis of esophageal cancer, and our results offered new statistics in order to facilitate the UICC - TNM reclassification - making process.更多还原