CAJ | 학술논문

目的：探讨N1期食管鳞癌淋巴结转移规律及其与预后的关系。方法回顾性分析2005年1月至2008年12月间天津医科大学肿瘤医院行食管癌根治术且术后病理诊断为N1期（1～2枚淋巴结转移）的126例患者的临床及随访资料，分析各组淋巴结转移情况及其对预后的影响。结果126例患者中仅1枚淋巴结转移者70例，2枚淋巴结转移者56例。上纵隔淋巴结、中下食管旁淋巴结、贲门周围淋巴结和胃左动脉旁淋巴结的早期转移率较高，分别为53．8％（14/26）、38．3％（41/107）、34．5％（30/87）和36．8％（39/106）。隆突下淋巴结转移（P＝0．031）和中下食管旁淋巴结转移（P＝0．042）是影响食管鳞癌早期淋巴结转移患者的独立预后因素。隆突下淋巴结转移者5年生存率明显低于其他部位淋巴结转移者（8％比26％，P＝0．004）；而仅中下食管旁淋巴结转移者5年生存率则明显高于其他部位淋巴结转移者（33％比12％，P＝0．029）。结论 N1期食管鳞癌淋巴结易转移至上纵隔、中下食管旁、贲门周围和胃左动脉旁淋巴结等部位，而隆突下及中下食管旁淋巴结转移是N1期患者的独立预后因素。
목적：탐토N1기식관린암림파결전이규률급기여예후적관계。방법회고성분석2005년1월지2008년12월간천진의과대학종류의원행식관암근치술차술후병리진단위N1기（1～2매림파결전이）적126례환자적림상급수방자료，분석각조림파결전이정황급기대예후적영향。결과126례환자중부1매림파결전이자70례，2매림파결전이자56례。상종격림파결、중하식관방림파결、분문주위림파결화위좌동맥방림파결적조기전이솔교고，분별위53．8％（14/26）、38．3％（41/107）、34．5％（30/87）화36．8％（39/106）。륭돌하림파결전이（P＝0．031）화중하식관방림파결전이（P＝0．042）시영향식관린암조기림파결전이환자적독립예후인소。륭돌하림파결전이자5년생존솔명현저우기타부위림파결전이자（8％비26％，P＝0．004）；이부중하식관방림파결전이자5년생존솔칙명현고우기타부위림파결전이자（33％비12％，P＝0．029）。결론 N1기식관린암림파결역전이지상종격、중하식관방、분문주위화위좌동맥방림파결등부위，이륭돌하급중하식관방림파결전이시N1기환자적독립예후인소。
Objective To investigate the pattern of early lymph node metastasis of thoracic esophageal squamous cell carcinoma and its prognostic value. Methods Clinical and follow-up data of 126 patients with pathological stage pN1 of esophageal squamous cell carcinoma undergoing radical esophagectomy in our department from January 2005 to December 2008 were analyzed retrospectively. Impact of lymph node metastasis pattern on prognosis was investigated. Results The relatively common sites of lymph node metastasis were upper mediastinum ( 53 . 8%) , middle and lower thoracic paraesophageal (38.3%), right and left cardiac (34.4%) and the left gastric artery (36.8%). Univariate analysis showed that the lymph node metastasis of subcarinal , middle and lower thoracic paraesophageal and the left gastric artery was associated with 5-year survival rate. Multivariate analysis revealed that the presence of subcarinal and middle and lower thoracic paraesophagea lymph node metastasis was an independent risk factor of survival. Conclusions Upper mediastinal, middle and lower thoracic paraesophageal, right and left cardiac and the left gastric artery are the earliest lymph node metastasis sites of esophageal squamous cell carcinoma. The presence of subcarinal and middle and lower thoracic paraesophagea lymph node metastasis is an independent risk factor of survival. Patient prognosis should be analyzed with lymph node metastasis pattern based on the 7th edition UICC-AJCC TNM classification system.