CAJ | 학술논문

目的探讨pN0期食管癌病人Ivor-Lewis手术后淋巴结转移性复发的危险因素.方法对2001年1月至2005年1月间接受Ivor-Lewis手术治疗的82例pN0期胸中段食管鳞癌病人进行前瞻性研究,用RT-PCR检测食管癌组织中淋巴管生成因子C(VEGF-C)mRNA和淋巴结组织中上皮标志物(Mucin1)mRNA的表达;Kaplan-Meier法计算复发率;Log-rank检验比较复发率;Cox回归多因素分析判定独立的危险因素.结果 42例食管癌组织中检测到VEGF-C mRNA表达;23例至少在1枚淋巴结中检测到Mucin1 mRNA表达,诊断为淋巴结微转移;手术后3年内37例发生淋巴结转移;T分期与病人3年内淋巴结转移的发生率相关(P＜0.05);有VEGF-C mRNA表达者3年内淋巴结转移发生率显著高于无VEGF-C mRNA表达者(P＜0.01);有淋巴结微转移者3年内淋巴结转移的发生率显著高于无淋巴结微转移者(P＜0.01).Cox回归分析显示T分期、食管癌组织中VEGF-C mRNA表达和淋巴结微转移是病人手术后3年内淋巴结转移的独立危险因素.结论 T分期、食管癌组织中VEGF-C mRNA表达和淋巴结微转移是pN0食管癌病人Ivor-Lewis手术后淋巴结转移性复发的独立危险因素.
목적 탐토pN0기식관암병인Ivor-Lewis수술후림파결전이성복발적위험인소.방법 대2001년1월지2005년1월간접수Ivor-Lewis수술치료적82례pN0기흉중단식관린암병인진행전첨성연구,용RT-PCR검측식관암조직중림파관생성인자C(VEGF-C)mRNA화림파결조직중상피표지물(Mucin1)mRNA적표체;Kaplan-Meier법계산복발솔;Log-rank검험비교복발솔;Cox회귀다인소분석판정독립적위험인소.결과 42례식관암조직중검측도VEGF-C mRNA표체;23례지소재1매림파결중검측도Mucin1 mRNA표체,진단위림파결미전이;수술후3년내37례발생림파결전이;T분기여병인3년내림파결전이적발생솔상관(P＜0.05);유VEGF-C mRNA표체자3년내림파결전이발생솔현저고우무VEGF-C mRNA표체자(P＜0.01);유림파결미전이자3년내림파결전이적발생솔현저고우무림파결미전이자(P＜0.01).Cox회귀분석현시T분기、식관암조직중VEGF-C mRNA표체화림파결미전이시병인수술후3년내림파결전이적독립위험인소.결론 T분기、식관암조직중VEGF-C mRNA표체화림파결미전이시pN0식관암병인Ivor-Lewis수술후림파결전이성복발적독립위험인소.
Objective To investigate the risk factors with lymph node metastatic recurrence in patients with N0 esophageal cancer after Ivor-Lewis Esophagectomy. Methods The subjects were 82 patients with pN0 esophageal cancer who underwent Ivor-Lewis esophagectomy from January 2001 to January 2005. By using RT-PCR, VEGF-C mRNA was detected in tumor issues, and Mucin l( MUC1 )mRNA was detected in lymph nodes. The Kaplan-Meier method was used to calculate the survival rate and lymph nodal metastatic rate. Log-rank test was performed to compare the recurrence rate, and Cox regression multivariate analysis was performed to determine independent prognostic factors. Results VEGF-C mRNA was identified in 42 patients (51.22%), and MUC1 mRNA was identified in 23 patients(28.05% )from at least 1 lymph node station . The diagnosis of lymph node micrometastasis (LNMM) was based on the detection of MUC1 mRNA. The first recurrence exhibiting lymph node metastasis was recognized in 37 patients (45.1%) at the first 3 years after operation and this was significantly associated with T status ( P ＜ 0. 05 ). Lymph node metastatic rate for patients with VEGF-C mRNA expression in tumor issues was significantly higher than that for patients without VEGF-C mRNA expression( P ＜0. 01 ). And lymph node metastatic rate for patients with LNMM was significantly higher than that for patients without LNMM ( P ＜0. 01 ). The results of multivariate analysis confirmed that T status, VEGF-C mRNA expression in tumor issues and LNMM were independent relevant factors. Conclusion Status,VEGF-C mRNA expression in tumor issues and LNMM in patients with N0 esophageal cancer were independent risk factors for 3-year lymph node metastatic recurrence after Ivor-Lewis Esophagectomy.