胸中段食管鳞状细胞癌伴腹腔淋巴结转移及其预后的临床研究

摘要

目的 了解胸中段食管鳞状细胞癌伴腹腔淋巴结转移的方式,分析预后的影响因素.方法 对1998年1月至2003年1月接受手术治疗的368例胸中段食管鳞状细胞癌患者进行回顾性研究.本组男性289例,女性79例,年龄38～79岁,平均56岁.术前临床分期I～Ⅲ期.全部患者采用Ivor-Lewis手术(右胸及上腹部两切口)行食管大部切除加胸腹二野淋巴结清扫.全组患者平均随访时间68个月.结果 腹腔淋巴结转移58例(15.8%),其中T1-2患者占36.2%(21/58);有13.8%(8/58)的患者为跳跃性腹腔淋巴结转移,均发生在T1-2患者中.腹腔淋巴结转移患者5年生存率为10.3%,低于胸腔淋巴结转移患者的18.3%.远处腹腔淋巴结转移患者预后极差,无1例达到5年生存(0/16).COX多因素分析结果 显示,淋巴结转移数目≥5枚和远处腹腔淋巴结转移是腹腔淋巴结转移患者的独立预后因素.结论 胸中段食管癌腹腔淋巴结转移的发生率较高,应该选择有利于腹腔淋巴结广泛清扫的手术方式.腹腔淋巴结转移患者的预后不良,尤其淋巴结转移数目较多和远处淋巴结转移的患者预后更差.%Objective To investigate the patterns of abdominal lymph node metastasis in patients with the middle thoracic esophageal squamous cell carcinoma and to evaluate the prognostic factors.Methods Three hundred and sixty-eight patients with the middle thoracic esophageal squamous cell carcinoma from January 1998 to January 2003 were reviewed.There were 289 male and 79 female patients.The age ranged from 38 to 79 years,with a mean of 56 years.Preoperative clinical stage was stage Ⅰ to Ⅲ,and all patients underwent Ivor-Lewis esophagectomy with two-field lymphadenectomy.Follow-up was completed for all patients with a mean time of 68 months.Survival rate was calculated by Kaplan-Meier method.COX regression analysis was performed to identify risk prognostic factors.Results Abdominal lymph node metastasis occurred in 58(15.8%)patients,with 36.2%(21/58)of them being in stage T1 or T2.Skipping abdominal lymph node metastasis was recognized in 13.8%(8/58)patients,with all of them being in stage T1 or T2.The overall 5-year survival rate of patients with abdominal lymph node metastasis (10.3%)was lower than that of those with thoracic lymph node metastasis(18.3%).The prognosis of patients with distant abdominal lymph node metastasis was bad,and nobody could survive over 5 years.COX analysis showed that 5 or more positive nodes and distant abdominal node metastasis were independent risk factors of patients with abdominal lymph node metastasis.Condusions Abdominal lymph nede metastasis in patients with the middle thoracic esophageal squamous cell carcinoma occurs frequently,and the surgery favorable for extensive abdominal lymph node dissection should be selected.The prognosis of patients with abdominal lymph node metastasis is poor,especially those with more positive nodes and distant abdominal node metastasis.