CAJ | 학술논문

目的对照三野与二野淋巴结清扫对胸段食管鳞癌患者术后生存的影响,探讨能从三野淋巴结清扫中获益的患者亚群.方法 1999年至2007年福建省肿瘤医院接受颈胸腹三切口根治性手术的胸段食管鳞癌患者1 551例,分别接受三野淋巴结清扫(1 131例)与二野淋巴结清扫(420例).回顾性分析患者的临床资料及区域淋巴结转移情况,采用Kaplan-Meier方法分析食管癌患者的术后生存,不同组别之间的生存比较采用Log-Rank检验;采用Cox比例模型对食管癌患者预后相关因素进行多因素回归分析.结果三野组与二野组在患者年龄、性别及肿瘤浸润深度方面无显著差异;两组患者在肿瘤位置、淋巴结转移及病理分期上具有明显差异,三野组相对二野组胸上段癌比例更高(17.6％对9.8％),淋巴结转移率更高(62.7％对52.9％);三野组N分期及TNM分期均偏晚.Cox多因素回归分析显示,淋巴结清扫方式(三野组对二野组,P =0.001)是胸段食管鳞癌患者的独立预后因素.对胸上段食管鳞癌,三野淋巴结清扫相对于二野淋巴结清扫能显著延长患者术后生存(P=0.002,5年生存率53.2％对34.1％).胸中下段食管鳞癌患者,如无淋巴结转移(N0),三野清扫有延长术后生存的趋势(5年生存率77.5％对70.7％),但差异无统计学意义(P=0.235);淋巴结转移个数为1～6个(N1～2)的胸中下段食管鳞癌,如伴有纵隔淋巴结转移,三野淋巴结清扫相对于二野清扫能显著延长患者术后生存(P =0.006,5年生存率41.1％对32.8％);淋巴结转移≥7个(N3)的胸中下段食管鳞癌,增加颈部淋巴结清扫无明显的生存获益.结论淋巴结清扫方式是胸段食管鳞癌患者的独立预后因素.胸上段食管鳞癌及淋巴结转移1～6个且伴有纵隔淋巴结转移的胸中下段食管鳞癌,行三野淋巴结清扫较二野淋巴结清扫能显著延长患者术后生存.
목적 대조삼야여이야림파결청소대흉단식관린암환자술후생존적영향,탐토능종삼야림파결청소중획익적환자아군.방법 1999년지2007년복건성종류의원접수경흉복삼절구근치성수술적흉단식관린암환자1 551례,분별접수삼야림파결청소(1 131례)여이야림파결청소(420례).회고성분석환자적림상자료급구역림파결전이정황,채용Kaplan-Meier방법분석식관암환자적술후생존,불동조별지간적생존비교채용Log-Rank검험;채용Cox비례모형대식관암환자예후상관인소진행다인소회귀분석.결과 삼야조여이야조재환자년령、성별급종류침윤심도방면무현저차이;량조환자재종류위치、림파결전이급병리분기상구유명현차이,삼야조상대이야조흉상단암비례경고(17.6％대9.8％),림파결전이솔경고(62.7％대52.9％);삼야조N분기급TNM분기균편만.Cox다인소회귀분석현시,림파결청소방식(삼야조대이야조,P =0.001)시흉단식관린암환자적독립예후인소.대흉상단식관린암,삼야림파결청소상대우이야림파결청소능현저연장환자술후생존(P=0.002,5년생존솔53.2％대34.1％).흉중하단식관린암환자,여무림파결전이(N0),삼야청소유연장술후생존적추세(5년생존솔77.5％대70.7％),단차이무통계학의의(P=0.235);림파결전이개수위1～6개(N1～2)적흉중하단식관린암,여반유종격림파결전이,삼야림파결청소상대우이야청소능현저연장환자술후생존(P =0.006,5년생존솔41.1％대32.8％);림파결전이≥7개(N3)적흉중하단식관린암,증가경부림파결청소무명현적생존획익.결론 림파결청소방식시흉단식관린암환자적독립예후인소.흉상단식관린암급림파결전이1～6개차반유종격림파결전이적흉중하단식관린암,행삼야림파결청소교이야림파결청소능현저연장환자술후생존.
Objective To compare survival according to the extent of lymph node dissection in patients with thoracic esophageal squamous cell carcinoma.To identify the subgroups of patients that could get survival benefit from three-field lymph node dissection.Methods Between January 1999 and December 2007,1551 patients with thoracic esophageal squamous cell carcinoma received esophagectomy plus three-field lymph node dissection (3 FL) (n =1131) or two-field lymph node dissection (2FL) (n =420).We retrospectively analyzed the clinical characteristics and patterns of lymphatic spread of thoracic esophageal squamous cell carcinoma.Survival rates between 3FL and 2FL were compared using the Kaplan-Meier method and Log-Rank test.Multivariate analysis were also performed to assess the element which affect the survival in 3FL and 2FL group by Cox regression.Results No significant differences in age,gender and depth of tumor invasion were found between 3 FL group and 2FL group.The 3FL group included more patients with upper thoracic esophageal tumors(17.6％ vs.9.8％) and patients with lymph node metastasis(LNM) (62.7％ vs.52.9％).Cox-proportional multivariate analysis showed that extent of lymph node dissection(3FL vs 2FL) was a significant prognostic factor in overall survival; 3 FL was beneficial for patients with upper thoracic esophageal tumors(P =0.002,5-year survival rate 53.2％ vs.34.1％).The 3FL group in patients with middle/lower thoracic esophageal tumors who had no LNMs(N0) had better 5-year survival than the 2FL group(5-year survival rate 77.5％ vs.70.7％),but no significant differences were found (P =0.235).or; Among patients with middle/lower thoracic esophageal tumors who had 1-6 LNMs (N1-N2),3 FL was beneficial for patients with mediastinum LNMs (P =0.006,5-year survival rate 41.1％ vs.32.8％) For patients with ≥7 LNMs(N3),cervical lymphadenectomy did not show additional survival benefits.Conclusion Our findings suggest that extent of lymph node dissection(3FL vs 2FL) is a significant prognostic factor for thoracic esophageal squamous cell carcinoma.3FL offers survival benefit over 2FL in patients with upper thoracic esophageal tumors or patients with middle/lower thoracic esophageal tumors who have 1-6 LNMs with mediastinum lymph node metastasis.