CAJ | 학술논문

目的分析影响颈部淋巴结转移胸段食管鳞癌术后患者的预后因素,探讨、验证第7版美国癌症联合委员会(AJCC)的食管癌分期标准.方法选择1993年1月至2007年3月间胸段食管鳞癌三野淋巴结清扫根治术后患者1 715例,按第7版AJCC食管癌分期标准进行重新分期,分析其预后影响因素和术后复发转移模式.结果 1 715例患者中,颈部淋巴结转移547例,颈部淋巴结转移率为31.9％.其中胸上段、胸中段、胸下段的颈部淋巴结转移率分别为44.2％ (121/274)、31.5％(403/1281)和14.4％ (23/160,P＜0.001).547例颈部淋巴结转移患者中,单纯手术296例,术后放疗251例.颈部淋巴结转移患者的5年生存率为27.7％,中位生存时间为27.5个月.其中单纯手术组和术后放疗组的5年总生存率分别为21.3％和34.2％,中位生存时间分别为21.9和35.4个月(P ＜0.001).多因素分析显示,性别、X线病变长度、N分期、AJCC分期和治疗方法为影响颈部淋巴结转移的胸段食管鳞癌患者预后的独立因素,肿瘤部位、pT分期、N分期和AJCC分期为影响单纯手术患者预后的独立因素,N分期为影响术后放疗患者预后的独立因素.结论颈部淋巴结转移胸段食管鳞癌术后患者的预后较好,支持第7版AJCC食管癌分期中将颈部淋巴结归属为区域淋巴结.
목적 분석영향경부림파결전이흉단식관린암술후환자적예후인소,탐토、험증제7판미국암증연합위원회(AJCC)적식관암분기표준.방법 선택1993년1월지2007년3월간흉단식관린암삼야림파결청소근치술후환자1 715례,안제7판AJCC식관암분기표준진행중신분기,분석기예후영향인소화술후복발전이모식.결과 1 715례환자중,경부림파결전이547례,경부림파결전이솔위31.9％.기중흉상단、흉중단、흉하단적경부림파결전이솔분별위44.2％ (121/274)、31.5％(403/1281)화14.4％ (23/160,P＜0.001).547례경부림파결전이환자중,단순수술296례,술후방료251례.경부림파결전이환자적5년생존솔위27.7％,중위생존시간위27.5개월.기중단순수술조화술후방료조적5년총생존솔분별위21.3％화34.2％,중위생존시간분별위21.9화35.4개월(P ＜0.001).다인소분석현시,성별、X선병변장도、N분기、AJCC분기화치료방법위영향경부림파결전이적흉단식관린암환자예후적독립인소,종류부위、pT분기、N분기화AJCC분기위영향단순수술환자예후적독립인소,N분기위영향술후방료환자예후적독립인소.결론 경부림파결전이흉단식관린암술후환자적예후교호,지지제7판AJCC식관암분기중장경부림파결귀속위구역림파결.
Objective To analyze the prognostic factors of cervical lymph node metastasis (CLN) in thoracic esophageal squamous cell carcinoma (TESCC),and to probe and verify the esophageal carcinoma staging of the 7th edition of American Joint Committee on Cancer (AJCC) TNM staging system.Methods A total of 1 715 TESCC patients underwent radical esophagectomy plus three-field lymph node dissection at Fujian Provincial Cancer Hospital between January 1993 and March 2007.547 patients had pathological metastasis of CLN,and 296 patients received surgery only (S group) and 251 patients received postoperative radiotherapy (S + R group).The prognostic factors were analyzed and the pattern of recurrence and metastases was studied according to the esophageal carcinoma staging criteria of the 7th edition of AJCC TNM staging system.Results The metastasis rate of CLN was 31.9％ for the entire group,44.2％,31.5％ and 14.4％ for the upper,middle and lower TESCC,respectively (P ＜ 0.001).The 5-year overall survival rate of the patients with metastatic CLN was 27.7％,and the median overall survival time was 27.5 months.The 5-year survival rate was 21.3％ in the S group and 34.2％ in the S + R group,and the median survival time was 21.9 months in the S group and 35.4 months in the S + R group (P ＜ 0.001).Multivariate analysis showed that gender,lesion length in X-ray,N stage,AJCC stage and treatment modality were independent prognostic factors of CLN metastasis in TESCC.Independent prognostic factors for S group included the primary tumor site,pT stage,N stage and AJCC stage,and N stage was an independent prognostic factor for the S + R group.Conclusions TESCC with CLN metastasis have a better prognosis after surgery.It supports that cervical lymph nodes belong to regional lymph nodes classified in the 7th edition of AJCC TNM staging system.