CAJ | 학술논문

目的探讨淋巴结跳跃转移与食管胸中段鳞癌临床病理因素的相关性及其预后价值.方法术后病理证实有淋巴结转移的胸中段食管鳞癌患者695例,1999年1月至2007年12月接受McKeown术式.回顾性分析患者的临床病理资料及与淋巴结跳跃转移的相关性,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比例模型对患者预后相关因素进行多因素回归分析.结果 226例(32.5％)患者发生淋巴结跳跃转移,469例(67.5％)患者为淋巴结连续转移.两组患者年龄、性别、肿瘤分化程度及淋巴结清扫范围差异均无统计学意义;两组患者间肿瘤浸润深度(T分期)及淋巴结转移个数(N分期)差异有统计学意义;淋巴结跳跃转移更多发生在相对早期的患者.单因素生存分析显示,淋巴结跳跃转移患者预后明显好于连续转移患者(P＜0.001).Cox多因素回归分析显示,淋巴结跳跃性转移与食管癌预后无明显相关性.不同N分期亚组中,淋巴结跳跃转移组预后与连续转移组差异无统计学意义.T1-2期患者,跳跃转移预后与连续转移5年生存率差异无统计学意义(P =0.059);T3-4期患者,跳跃转移预后与连续转移5年生存率差异显著(P=0.001).根据不同淋巴结转移部位,将淋巴结跳跃转移病例分为颈部及腹腔淋巴结转移组(45例,19.9％)、单纯颈部淋巴结转移组(120例,53.1％)和单纯腹腔淋巴结转移组(61例,27.0％),3组患者淋巴结转移个数(N分期)差异有显著统计学意义(P ＜0.001),不同N分期亚组术后生存差异无统计学意义.结论淋巴结跳跃转移相对于淋巴结连续转移,发生在肿瘤的更早期.三野淋巴结清扫可减少局部病变较明显的T3-4期食管鳞癌患者复发,提高这部分患者的5年生存率.淋巴结跳跃性转移不是食管胸中段鳞癌的独立预后因素.
목적 탐토림파결도약전이여식관흉중단린암림상병리인소적상관성급기예후개치.방법 술후병리증실유림파결전이적흉중단식관린암환자695례,1999년1월지2007년12월접수McKeown술식.회고성분석환자적림상병리자료급여림파결도약전이적상관성,채용Kaplan-Meier방법분석식관암환자적술후생존,불동조별지간적생존비교채용Log-Rank검험;채용Cox비례모형대환자예후상관인소진행다인소회귀분석.결과 226례(32.5％)환자발생림파결도약전이,469례(67.5％)환자위림파결련속전이.량조환자년령、성별、종류분화정도급림파결청소범위차이균무통계학의의;량조환자간종류침윤심도(T분기)급림파결전이개수(N분기)차이유통계학의의;림파결도약전이경다발생재상대조기적환자.단인소생존분석현시,림파결도약전이환자예후명현호우련속전이환자(P＜0.001).Cox다인소회귀분석현시,림파결도약성전이여식관암예후무명현상관성.불동N분기아조중,림파결도약전이조예후여련속전이조차이무통계학의의.T1-2기환자,도약전이예후여련속전이5년생존솔차이무통계학의의(P =0.059);T3-4기환자,도약전이예후여련속전이5년생존솔차이현저(P=0.001).근거불동림파결전이부위,장림파결도약전이병례분위경부급복강림파결전이조(45례,19.9％)、단순경부림파결전이조(120례,53.1％)화단순복강림파결전이조(61례,27.0％),3조환자림파결전이개수(N분기)차이유현저통계학의의(P ＜0.001),불동N분기아조술후생존차이무통계학의의.결론 림파결도약전이상대우림파결련속전이,발생재종류적경조기.삼야림파결청소가감소국부병변교명현적T3-4기식관린암환자복발,제고저부분환자적5년생존솔.림파결도약성전이불시식관흉중단린암적독립예후인소.
Objective To investigate the relationship of nodal skip metastasis(NSM) and clinicopathological factors of middle thoracic esophageal squamous cell carcinoma patients.Methods Between January 1999 and December 2007,695 patients with middle thoracic esophageal squamous cell carcinoma who had lymph node metastasis were reviewed.All patients received McKeown esophagectomy.We retrospectively analyzed the clinical characteristics and NSM status.Survival rates were compared using the Kaplan-Meier method and Log-Rank test.Multivariate analysis were also performed to assess the element which affect the survival by Cox regression.Results NSM were present in 226 (32.5％) patients.No significant differences in age,gender,tumor differentiation and extent of lymph node dissection depth of tumor invasion were found between skip metastasis group and continuous metastasis group.The NSM group included more patients with earlier T stage and N stage.Univariate analysis displayed that NSM was beneficial for patients with middle thoracic esophageal tumors (P ＜ 0.001).Cox-proportional multivariate analysis showed NSM was not a significant prognostic factor in overall survival.The overall survival did not differ according to NSM status in subgroups with different N stage.T1-2 patients,no significant difference of 5-year survival rate was found between skip metastasis group and continuous metastasis group(P =0.059).T3-4 patients,significant difference of 5-year survival rate was found between skip metastasis group and continuous metastasis group(P =0.001).NSM patients were then separated into 3 groups based on the extent of metastasis lymph nodes:both cervical and abdominal NSM (n =45,19.9％),cervical NSM (n =120,53.1％) and abdominal NSM (n =61,27.0％).The number of metastasis lymph nodes was significantly different among the three groups.No survival differences were observed among the three groups.Conclusion NSM is more frequently in the earlier stage compared to continuous metastasis.Three field lymphadenectomy can reduce the recurrence of T3-4 patients,and improve the survival rate of five years.The presence of NSM does not predict prognosis.