食管鳞癌浸润深度（T分期）与淋巴结转移的关系

摘要

目的：探讨食管鳞癌浸润深度（T 分期）与淋巴结转移的关系，为临床评判淋巴结转移情况提供重要依据。方法纳入分析的89492例食管鳞癌手术患者，均来自郑州大学第一附属医院河南省食管癌重点开放实验室50万例食管癌和贲门癌临床信息资料库，其中男59143例，年龄（59±8）岁；女30349例，年龄（60±8）岁。分析食管鳞癌浸润深度（T 分期）与淋巴结转移的关系。结果在纳入分析的89492例食管鳞癌患者中，Tis、T1a、T1b、T2、T3、T4a和 T4b期患者所占的比率依次为0.7%、2.9%、6.8%、30.6%、58.5%、0.4%和0.1%；35581例发生淋巴结转移，淋巴结转移率为39.8%（35581/89492）；103932枚淋巴结发生转移，淋巴结转移度为11.5%（103932/900771）。在 Tis ~ T4b分期中，T4a 期淋巴结转移阳性率和淋巴结转移度均最高（58.3%和22.8%），其次是 T4b期（55.2%和14.8%）。随着 T 分期的增加（Tis ~ T4a ），淋巴结转移率和淋巴结转移度增加（χ2=3132.13，P <0.001；χ2=236.12，P <0.001）、转移风险增高（R2=0.951）。不同 T分期的淋巴结转移率和淋巴结转移度之间均呈显著性正相关（ r =0.975，P <0.001；r =0.884，P <0.001）。结论食管鳞癌浸润深度（T 分期）与淋巴结转移密切相关，提示 T 分期可以作为临床上间接评判淋巴结转移的重要参考指标。%Objective To explore the relationship between invasive depth(T stage)and lymph node metastasis in the esophageal squamous cell carcinoma,and to provide evidence for clinical evaluation of lymph node metastasis.Methods The enrolled 89 492 patients with esophageal squamous cell carcinoma in this study were from the 50 thousand cases of the esophageal cancer and cardiac cancer clinical information database in Henan Key Laboratory for Esophageal Cancer Research of the First Affiliated Hospital of Zhengzhou University. Of the patients,there were 59 143 males with an average age of 59 ± 8,and 30 349 females with an average age of 60 ± 8. The relationship be-tween invasive depth(T stage)and lymph node metastasis was analyzed. Results Of the 89 492 patients with e-sophageal squamous cell carcinoma,the ratio of patients with Tis ,T1a ,T1b ,T2 ,T3 ,T4a ,T4b period was 0. 7% ,2. 9% , 6. 8% ,30. 6% ,6. 8% ,0. 4% and 0. 1% ,respectively;35 581 patients had lymph node metastasis in 89 492 cases, and the rate is 39. 8%(35 581 / 89 492);900 771 lymph nodes were removed in total,and 103 932 nodes were proved to be metastasis,so the lymph node metastasis ratio was 11. 5%(103 932 / 900 771). From Tis to T4b stage, the positive rate of lymph node metastasis and the ratio of lymph node metastasis were highest(58. 3% and 22. 8% ),followed by T4b(55. 2% and 14. 8% ). The higher the T stages(Tis-T4a ),the higher the lymph node metastasis rate and ratio(χ2 = 3132. 13,P < 0. 001;χ2 = 236. 12,P < 0. 001),the higher the risk of lymph node metastasis(R2 = 0. 951). There was a significant positive correlation between lymph node metastasis rate and metas-tasis ratio in the different T stages(r = 0. 975,P < 0. 001;r = 0. 884,P < 0. 001). Conclusion Depth of invasion (T stage)was closely related to lymph node metastasis in the esophageal squamous cell carcinoma,suggesting that T stage could be used as an important reference index for clinical evaluation of lymph node metastasis.