切换至 "中华医学电子期刊资源库"

中华腔镜外科杂志(电子版) ›› 2018, Vol. 11 ›› Issue (02) : 98 -102. doi: 10.3877/cma.j.issn.1674-6899.2018.02.009

所属专题: 文献

论著

微创食管癌切除术后淋巴结转移规律及预后分析
亓磊1, 田辉,1, 李林1, 李树海1, 岳韦名1, 高存1, 司立博1, 鲁铭1, 程传乐1   
  1. 1. 250012 济南,山东大学齐鲁医院胸外科
  • 收稿日期:2017-12-16 出版日期:2018-04-30
  • 通信作者: 田辉
  • 基金资助:
    国家自然科学基金(81672292); 泰山学者工程专项经费资助(ts201712087)

Clinicopathological features of lymph node metastasis and prognostic factors in esophageal cancer treated with minimally invasive esophagectomy

Lei Qi1, Hui Tian,1, Lin Li1, Shuhai Li1, Weiming Yue1, Cun Gao1, Libo Si1, Ming Lu1, Chuanle Cheng1   

  1. 1. Department of Thoracic Surgery, Qilu Hospital of Shandong University, Jinan 250012, China
  • Received:2017-12-16 Published:2018-04-30
  • Corresponding author: Hui Tian
  • About author:
    Corresponding auther: Tian hui, Email:
引用本文:

亓磊, 田辉, 李林, 李树海, 岳韦名, 高存, 司立博, 鲁铭, 程传乐. 微创食管癌切除术后淋巴结转移规律及预后分析[J/OL]. 中华腔镜外科杂志(电子版), 2018, 11(02): 98-102.

Lei Qi, Hui Tian, Lin Li, Shuhai Li, Weiming Yue, Cun Gao, Libo Si, Ming Lu, Chuanle Cheng. Clinicopathological features of lymph node metastasis and prognostic factors in esophageal cancer treated with minimally invasive esophagectomy[J/OL]. Chinese Journal of Laparoscopic Surgery(Electronic Edition), 2018, 11(02): 98-102.

目的

淋巴结转移是食管癌转移的主要方式,对食管癌患者预后有重要影响,本文探讨食管癌胸腹二区淋巴结的转移规律。

方法

选取2010年1月至2016年10月于山东大学齐鲁医院经微创食管癌切除术(minimally invasive esophagectomy, MIE)治疗的食管癌患者613例,参照日本食管肿瘤研究会(JEOG)淋巴结分区标准清扫淋巴结,统计各组淋巴结的转移率。对2010年1月至2013年10月行MIE治疗的203例食管癌患者进行生存分析。另外410例患者由于术后时间较短,随访数据未列入统计。

结果

胸上段食管癌较多发生上纵隔淋巴结转移,其左、右喉返神经旁淋巴结转移率分别高达35.9%、40.7%,均显著高于胸中段和胸下段食管癌;胸中段食管癌既向上发生上纵隔淋巴结转移,又向下发生腹腔淋巴结转移;胸下段食管癌主要向胃周淋巴结转移,其中胃左动脉旁淋巴结转移率最高。单因素分析结果显示,病变长度、肿瘤分化程度、肿瘤浸润深度、淋巴结转移程度是影响食管癌患者预后的相关因素(P< 0.05)。COX多因素回归分析结果显示,肿瘤低分化和淋巴结转移是影响食管癌患者预后不良的独立危险因素(P< 0.05)。

结论

手术治疗食管癌应重点清扫双侧喉返神经旁淋巴结和胃左动脉旁淋巴结。

Objective

The role of lymph node is vital in the prognosis of esophageal carcinoma. This study is to explore the pattern of thoraco-abdominal two-field lymphatic metastasis.

Methods

613 patients with esophageal carcinoma visiting Qilu Hospital of Shandong University from Jan.2010 to Oct. 2016 were included in this study. The lymph node metastasis rate of each group was counted according to the standard of lymph node division of the Japan Esophageal Cancer Research Association (JEOG). Survival analysis was performed in 203 patients from Jan. 2010 to Oct. 2013.

Results

Carcinoma of the upper thoracic esophagus mainly metastasized to mediastinal lymph nodes. The rates of metastasis to the left and right recurrent nerve lymph nodes were 35.9% and 40.7%, which were higher than that of middle-third and lower third of esophageal carcinoma. Carcinoma of the middle-third thoracic esophagus metastasized bidirectionally; and carcinoma of the lower-third thoracic esophagus mainly metastasized to the lymph nodes of the para-esophagus, lateral cardia and left gastric artery, among which the metastasis rate of left gastric artery was the highest. Univariate survival analysis showed that the lesion length, the degree of tumor differentiation, the depth of tumor invasion and lymph node metastasis were prognostic factors of esophageal carcinoma patients(P< 0.05). Multivariate analysis by COX regression showed that the low degree of tumor differentiation and status of lymph node metastasis were independent risk factors affecting the prognosis of esophageal carcinoma(P< 0.05).

Conclusions

Thus, it was important to clear the lymph nodes of the bilateral recurrent laryngeal nerve and left gastric artery to improve the survival rate of patients with thoracic esophageal carcinoma.

表1 613例食管癌患者不同部位肿瘤淋巴结转移状况[例(%)]
表2 影响203例食管癌患者预后的单因素分析
表3 影响203例食管癌患者预后的多因素分析
[1]
曹小琴. 食管癌发病水平及变化趋势 [J]. 中国肿瘤临床,2016,43(21) : 932-936.
[2]
任志鹏,温佳新,侯晓彬,等. 全腔镜联同期微创手术治疗食管、肺双原发癌[J/CD]. 中华腔镜外科杂志(电子版), 2015, 8(5): 317-320.
[3]
张真铭,王允. 微创手术治疗食管癌的现状 [J]. 中国胸心血管外科临床杂志,2014, 21(2): 264-269.
[4]
Hijiya N, Shibata T, Daa T, et al. Overexpression of cannabinoid receptor 1 in esophageal squamous cell carcinoma is correlated with metastasis to l lymph nodes and distant organs, and poor prognosis [J]. Pathol Int, 2017, 67(2): 83-90.
[5]
Hasegawa S, Yoshikawa T, Cho H, et al. Is adenocarcinoma of the esophagogastric junction different between japan and western countries the incidence and clinicopathological features at a japanese high-volume cancer center [J]. World J Surg, 2009, 33(1): 95-103.
[6]
Dutkowski P, Hommel G, Bottger T, et al. How many lymph nodes are needed for an accurate pN classification in esophageal cancer [J]. Hepatogastroenterology, 2008, 49(4): 176-180.
[7]
Altorki NK, Girardi L, Skinner DB, et al. En bloc esophagectomy improves survival for stage Ⅲ esophageal cancer[J]. Thorac Cardiovasc Surg, 1997, 114(9): 948-956.
[8]
叶凯,许建华,许双塔,等. 胸段食管鳞癌喉返神经旁淋巴结转移特点及临床意义 [J].中国肿瘤临床,2008, 35(17): 980-983.
[9]
Tachimori Y, Nagai Y, Kanamori N, et al. Pattern of lymph node metastases of esophageal squamous cell carcinoma based on the anatomical lymphatic drainage system [J]. DisEsophagus, 2011, 24(1): 33-38.
[10]
胡杨,李勇,赵雍凡,等. 食管癌手术中胃左动脉旁淋巴结切除的临床意义 [J]. 中国胸心血管外科临床杂志,2005, 12(5): 329-331.
[11]
陈远岷,刘德森,潘琪,等. 胸段食管癌重点清扫淋巴结的临床病理特点及预后分析 [J/CD]. 中华临床医师杂志(电子版), 2014, 13(8): 2403-2407.
[12]
罗晖,杨颖,汪华,等. 手辅助电视胸腔镜食管癌切除术的微创及淋巴结清扫效果研究 [J]. 中国医药导报,2013, 10(20): 33-37.
[13]
Li KK, Wang YJ, Liu XH, et al. The effect of postoperative complications on survival of patients after minimally invasive esophagectomy for esophageal cancer[J]. Surgical Endoscopy, 2016, 31(9): 1-8.
[14]
Levy RM, Pennathur A, Luketich JD. Randomized trial comparing minimally invasive esophagectomy and open esophagectomy: early perioperative outcomes appear improved with a minimally invasive approach[J]. Semin Thorac Cardiovasc Surg, 2012, 24(3): 153-154.
[15]
Perry Y, Fernando HC. Three-field minimally invasive esophagectomy: current results and technique [J]. J Thorac Cardiovasc Surgm, 2012, 144 (3): 63-66.
[16]
Spector R, Zheng Y, Yeap BY, et al. The 3-hole minimally invasive esophagectomy: a safe procedure following neoadjuvant chemotherapy and radiation [J]. Semin Thorac Cardiovasc Surg, 2015, 27(2): 205-215.
[1] 周世振, 朱兴亚, 袁庆港, 刘理想, 王凯, 缪骥, 丁超, 汪灏, 管文贤. 吲哚菁绿荧光成像技术在腹腔镜直肠癌侧方淋巴结清扫中的应用效果分析[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 44-47.
[2] 黄一博, 李至彦, 林晨, 陶亮, 王萌, 管文贤. 胃癌根治术中淋巴结示踪剂的研究进展[J/OL]. 中华普外科手术学杂志(电子版), 2024, 18(05): 586-588.
[3] 韩婧, 郝少龙, 康骅. 北京市单中心甲状腺癌患者临床特征的回顾分析[J/OL]. 中华普外科手术学杂志(电子版), 2024, 18(05): 490-493.
[4] 郭小琦, 张璞, 李小军, 余明, 王博. 口服醋酸泼尼松联合局部注射曲安奈德对食管早癌ESD术后食管狭窄及肺部感染的预防疗效分析[J/OL]. 中华肺部疾病杂志(电子版), 2024, 17(02): 288-291.
[5] 陆镜明, 韩大为, 任耀星, 黄天笑, 向俊西, 张谞丰, 吕毅, 王傅民. 基于术前影像组学的肝内胆管细胞癌淋巴结转移预测的系统性分析[J/OL]. 中华肝脏外科手术学电子杂志, 2024, 13(06): 852-858.
[6] 张伟伟, 陈启, 翁和语, 黄亮. 随机森林模型预测T1 期结直肠癌淋巴结转移的初步研究[J/OL]. 中华结直肠疾病电子杂志, 2024, 13(05): 389-393.
[7] 段伟, 刘飞, 许光源, 程宇豪, 陈星. 食管癌调强放疗计划剂量学参数差异对放射性肺炎发生及严重程度的影响[J/OL]. 中华消化病与影像杂志(电子版), 2024, 14(04): 320-324.
[8] 陶金华, 陈珊珊, 陈晓四. 阿帕替尼联合替吉奥治疗晚期食管癌的疗效与安全性影响因素评价[J/OL]. 中华消化病与影像杂志(电子版), 2024, 14(04): 325-329.
[9] 王曦娅, 尹弘青, 丁伟, 徐滨, 于海源, 马东升, 邵军. 桥本背景下甲状腺乳头状癌多参数分析预测大容量淋巴结转移[J/OL]. 中华临床医师杂志(电子版), 2024, 18(06): 548-554.
[10] 姜超, 夏旭东, 王功夏, 何向宇, 王海彬, 李媛. 磁共振DWI及其ADC对乳腺导管原位癌伴微浸润腋窝淋巴结转移的诊断价值[J/OL]. 中华介入放射学电子杂志, 2024, 12(03): 234-243.
[11] 王超, 王浩, 孙柏, 袁野, 羌伟光, 石红兵. 卡非佐米联合碘-125粒子照射促进人食管癌细胞KYSE-150凋亡的机制研究[J/OL]. 中华介入放射学电子杂志, 2024, 12(02): 106-113.
[12] 高鹏强, 林军鹏, 王佩元, 林辉, 周航, 魏文巍, 柳硕岩, 王枫. 胸段食管鳞状细胞癌中锁骨上淋巴结转移对预后的影响:一项大型回顾性研究[J/OL]. 中华胸部外科电子杂志, 2024, 11(04): 211-218.
[13] 李春光, 杨洋, 李斌, 华荣, 李志刚. 完全腹腔镜下管状胃制作技术在食管癌McKeown手术中的应用[J/OL]. 中华胸部外科电子杂志, 2024, 11(04): 219-224.
[14] 刘石健骢, 甘向峰, 吕良湛, 曹庆东. 机器人辅助充气式纵隔镜联合腹腔镜食管癌切除术初步探索[J/OL]. 中华胸部外科电子杂志, 2024, 11(02): 104-108.
[15] 卢琪珏, 李斌, 杨超, 华荣, 李春光, 李志刚. 改良Grillo气管重建术在颈段食管癌挽救性食管切除术中的应用[J/OL]. 中华胸部外科电子杂志, 2024, 11(02): 91-95.
阅读次数
全文
0
HTML PDF
最新录用 在线预览 正式出版 最新录用 在线预览 正式出版
0 0 0 0 0 0


摘要
48
最新录用 在线预览 正式出版
0 0 48
  来源 本网站 其他网站
  次数 32 16
  比例 67% 33%