CAJ | 학술논문

目的探讨病理N1期食管鳞状细胞癌淋巴结转移规律及其危险因素.方法回顾性分析2005年1月至2008年12月天津医科大学肿瘤医院食管肿瘤科181例接受食管癌切除术的病理N1期患者的临床资料.患者男性154例,女性27例;年龄38 ～ 84岁.手术采用左胸入路69例,右胸入路112例,均行系统性淋巴结清扫.应用x2检验和Logistic回归对各部位淋巴结转移与临床因素的相关性进行单因素和多因素分析.结果早期淋巴结转移率较高部位为中下食管旁(38.4％)、贲门周围(35.3％)和胃左动脉旁淋巴结(38.8％).单因素分析结果显示,中下食管旁淋巴结转移只与浸润深度有关(x2=11.754,P=0.009).上纵隔淋巴结转移与肿瘤部位有关(P=0.039).中下纵隔淋巴结转移与浸润深度(x2=8.694,P=0.034)和TNM分期(x2=6.906,P=0.032)有关.腹部淋巴结转移与肿瘤部位、肿瘤最大径、浸润深度和TNM分期均有关(x2 =5.713～16.749,P＜0.05).多因素分析结果显示,肿瘤部位为腹部淋巴结转移的独立危险因素.结论病理N1期食管鳞状细胞癌患者的淋巴结转移率与肿瘤部位、浸润深度、肿瘤最大径和TNM分期有关.术中应对淋巴结转移高发部位进行重点清扫.
목적 탐토병리N1기식관린상세포암림파결전이규률급기위험인소.방법 회고성분석2005년1월지2008년12월천진의과대학종류의원식관종류과181례접수식관암절제술적병리N1기환자적림상자료.환자남성154례,녀성27례;년령38 ～ 84세.수술채용좌흉입로69례,우흉입로112례,균행계통성림파결청소.응용x2검험화Logistic회귀대각부위림파결전이여림상인소적상관성진행단인소화다인소분석.결과 조기림파결전이솔교고부위위중하식관방(38.4％)、분문주위(35.3％)화위좌동맥방림파결(38.8％).단인소분석결과현시,중하식관방림파결전이지여침윤심도유관(x2=11.754,P=0.009).상종격림파결전이여종류부위유관(P=0.039).중하종격림파결전이여침윤심도(x2=8.694,P=0.034)화TNM분기(x2=6.906,P=0.032)유관.복부림파결전이여종류부위、종류최대경、침윤심도화TNM분기균유관(x2 =5.713～16.749,P＜0.05).다인소분석결과현시,종류부위위복부림파결전이적독립위험인소.결론 병리N1기식관린상세포암환자적림파결전이솔여종류부위、침윤심도、종류최대경화TNM분기유관.술중응대림파결전이고발부위진행중점청소.
Objective To analyze the pattern and the clinicopathologic risk factors of lymph node metastasis (LNM) in pN1 stage esophageal squamous cell carcinoma.Methods Clinical data of 181 patients (154 male and 27 female patients,aging from 38 to 84 years) who underwent esophagectomy during January 2005 and December 2008 were reviewed,including 69 cases through left thoracotomy and 1 12 cases through right thoracotomy.All patients underwent systematic lymphadenectomy.The risk factors related to lymph node metastasis were analyzed by x2 test and Logistic regression analysis.Results The relatively highest LNM site were middle and lower thoracic paraesophageal (38.4％),right and left cardiac (35.3％) and the left gastric artery (38.8％).The LNM of middle and lower thoracic paraesophageal was correlated with T stage (x2 =11.754,P =0.009).A correlation was also found among the LNM of upper mediastinum and the location of tumor (P =0.039).The T stage (x2 =8.694,P =0.034) and TNM stage (x2 =6.906,P =0.032) were the risk factors of the LNM of middle and lower mediastinum.The risk factors of the LNM of abdomen were the location of tumor,the length of tumor,T stage and TNM stage (x2 =5.713 to 16.749,P ＞ 0.05).Multivariate analysis showed that the location of tumor is the independent risk factors for the abdominal lymph node metastasis.Conclusions The relatively highest LNM sites are correlated with the location of tumor,T stage,the length of tumor and TNM stage.According to the risk factors of LNM,the relatively highest LNM sites should be mainly swept.