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) ›› 2020, Vol. 13 ›› Issue (03): 188 -192. doi: 10.3877/cma.j.issn.1674-6899.2020.03.013

所属专题: 文献资源库

综述 上一篇    

食管癌淋巴结转移规律及预测模型研究进展
范博士 1, 宋伟安 1, 龚太乾 1 , ( )   
  1. 1. 100048 北京,解放军总医院第六医学中心胸外科
  • 收稿日期:2020-04-24 出版日期:2020-06-30
  • 通信作者: 龚太乾
  • 基金资助:
    国家自然科学基金面上项目(81372556); 国家自然科学基金青年基金(81902433); 北京市自然科学基金资助项目(7204313); 解放军总医院医疗大数据及人工智能研发项目(2019MBD-027)

Lymph node metastasis and predictive model in esophageal carcinoma

Boshi Fan 1, Weian Song 1, Taiqian Gong 1 , ( )   

  1. 1. Department of Thoracic Surgery, the Sixth Medical Center, Chinese PLA General Hospital, Beijing 100048, China
  • Received:2020-04-24 Published:2020-06-30
  • Corresponding author: Taiqian Gong
  • About author:
    Corresponding Author: Gong Taiqian, Email:

食管的淋巴管网丰富,引流范围广泛,涉及颈、胸和腹等处20余组淋巴结。淋巴结转移状态也是确定食管癌分期的重要指标,是判断患者预后的独立因子。手术依然是食管癌治疗最重要的方式之一。然而,目前关于食管癌淋巴结转移规律和食管癌淋巴结清扫范围依然缺乏统一的认识。选择性三野淋巴结清扫似乎更符合个性化医疗和精准医疗的时代潮流,但由于影像学诊断颈部淋巴结转移的灵敏性和特异性不足,选择性三野淋巴结清扫仍需高质量的临床证据验证。基于大数据的数学建模和影像组学已辅助用于疾病的临床诊断、治疗和预后的临床抉择,对其深入的研究及发展将有助于食管癌相关的诊断和治疗。

The esophagus has a rich lymphatic network which covers a wide drainage area including more than 20 groups of lymph nodes in the neck, chest, and abdomen. Lymph node metastasis is an important descriptor to determine the stage of esophageal cancer, and correlates independently with the poor prognosis of patients. Surgery is still one of the most important treatments for esophageal cancer. However, there is still no unified consensus on the patterns of lymph nodes metastasis and extent of lymphadenectomy for esophageal cancer. Selective three-field lymphadenectomy seems to be a good choice and is consistent with the trend of personalized medicine. However, due to low sensitivity and specificity in imaging diagnosis of cervical metastatic lymph nodes, the efficacy of selective three-field lymphadenectomy still needs to be verified by high-quality clinical evidence. Big data-based mathematical models and radiomics have been applied to the clinical decisions on the diagnosis, treatment and prognosis of several diseases, and further research on these methods will contribute to esophageal cancer-related diagnosis and treatment.

3
Sohda M,Kuwano H. Current status and future prospects for esophageal cancer treatment[J]. Ann Thorac Cardiovasc Surg,2017,23(1):1-11.
4
赵越,毛友生. 胸段食管鳞状细胞癌淋巴结转移规律及淋巴结清扫方式的选择[J]. 中华胃肠外科杂志,2018,21(9):987-994.
5
袁勇,陈龙奇. AJCC第八版食管癌分期系统更新解读[J]. 中华外科杂志,2017,55(2):109-113.
6
中国抗癌协会食管癌专业委员会. 食管癌根治术胸部淋巴结清扫中国专家共识(2017版)[J]. 2017,16(11):1087-1090.
7
Wang Y,Zhu L,Xia W,et al. Anatomy of lymphatic drainage of the esophagus and lymph node metastasis of thoracic esophageal cancer[J]. Cancer Manag Res,2018,78(10):6295-6303.
8
Isono K, Sato H, Nakayama K. Results of a nationwide study on the three-field lymph node dissection of esophageal cancer[J]. Oncology,1991,48(5):411-420.
9
安丰山,黄金球,陈少湖. 217例胸段食管癌淋巴结转移及其对预后影响的分析[J]. 中国癌症杂志,2003,22(9):974-977.
10
柳硕岩,余志廉,朱坤寿. 472例胸段食管癌行颈、胸、腹三野淋巴结清扫术的临床研究[J]. 福建医药杂志,2005,27(6):38-40.
11
李斌,相加庆,张亚伟,等. 食管癌淋巴结转移特点及其危险因素[J]. 中华胃肠外科杂志,2011,14(9):711-714.
12
Feith M,Stein HJ,Siewert JR. Adenocarcinoma of the esophagogastric junction:surgical therapy based on 160 2 consecutive resected patients[J]. Surg Oncol Clin N Am,2006,15(4):751-764.
13
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.
14
张彦军,王军,张小龙. 393例食管胃结合部腺癌淋巴结转移的特征及其影响因素[J]. 中华肿瘤杂志,2016,38(9):672-676.
15
Wang F,Zheng Y,Wang Z,et al. Nodal skip metastasis in esophageal squamous cell carcinoma patients undergoing three-field lymphadenectomy[J]. Ann Thorac Surg,2017,104(4):1187-1193.
16
Liu J,Liu Q,Wang Y,et al. Nodal skip metastasis is associated with a relatively poor prognosis in thoracic esophageal squamous cell carcinoma[J]. Eur J Surg Oncol,2016,42(8):1202-1205.
17
郑庆丰,柳硕岩,朱坤,等. 淋巴结跳跃转移对食管胸中段鳞状细胞癌患者预后的影响[J]. 中华胸心外科杂志,2015,31(6):354-358.
18
姚光宇,范虹,张毅,等. 淋巴结跳跃转移对TXN>0M0分期原发性胸段食管鳞状细胞癌患者术后5年生存预测价值有限[J]. 中国临床医学,2015,25(5):700-703.
19
Cavallin F,Alfieri R,Scarpa M,et al. Nodal skip metastasis in thoracic esophageal squamous cell carcinoma:a cohort study[J]. BMC Surg,2017,17(1):49-49.
20
Zhu Z,Yu W,Li H,et al. Nodal skip metastasis is not a predictor of survival in thoracic esophageal squamous cell carcinoma[J]. Ann Surg Oncol,2013,20(9):3052-3058.
21
Prenzel KL,Bollschweiler E,Schr der W,et al. Prognostic relevance of skip metastases in esophageal cancer[J]. Ann Thorac Surg,2010,90(5):1662-1667.
22
Hagens ERC,Berge Henegouwen MI,Sandick JW,et al. Distribution of lymph node metastases in esophageal carcinoma [TIGER study]:study protocol of a multinational observational study[J]. BMC Cancer,2019,19(1):662-662.
23
刘玉,邹志强,袁耒,等. 胸段食管鳞状细胞癌喉返神经旁淋巴结转移规律探讨[J].中华胸心血管外科杂志,2018,34(2):79-81.
24
吴灿兴,张树亮,陈椿,等. 胸段食管鳞状细胞癌患者的喉返神经旁淋巴结转移特点[J/CD]. 中华胸部外科电子杂志,2016,3(1):21-24.
25
Li H, Yang S, Zhang Y, et al. Thoracic recurrent laryngeal lymph node metastases predict cervical node metastases and benefit from three-field dissection in selected patients with thoracic esophageal squamous cell carcinoma[J]. J Surg Oncol,2012,105(6):548-552.
26
Noguchi T,Wada S,Takeno S,et al. Two-step three-field lymph node dissection is beneficial for thoracic esophageal carcinoma[J].Dis Esophagus,2004,17(1):27-31.
27
沈国义,张文山,张奕,等. 术中胸内喉返神经旁淋巴结冰冻在指导胸段食管鳞状细胞癌三野淋巴结清扫的意义[J]. 福建医科大学学报,2017,51(4):240-243.
28
Nafteux P,Depypere L,Van Veer H, et al. Principles of esophageal cancer surgery,including surgical approaches and optimal node dissection(2- vs. 3-field)[J]. Ann Cardiothorac Surg,2017,6(2):152-158.
29
吴昌荣,薛恒川,朱宗海,等. 现代二野淋巴结清扫食管癌切除术的疗效分析[J]. 中华肿瘤杂志,2009,31(8):630-633.
30
柳硕岩,王镇,王枫. 胸段食管癌三野与二野加淋巴结清扫的选择[J]. 中华胃肠外科杂志,2016,19(9):975-978.
31
Nishihira T,Hirayama K,Mori S. A prospective randomized trial of extended cervical and superior mediastinal lymphadenectomy for carcinoma of the thoracic esophagus[J]. Am J Surg,1998,175(1):47-51.
32
Kato H. Lymph node dissection for thoracic esophageal carcinoma. two- and 3-feld lymph node dissection[J]. Ann Chir Gynaecol,1995,84(2):193-199.
1
Bray F,Ferlay J,Soerjomataram I,et al. Global cancer statistics 2018:globocan estimates of incidence and mortality worldwide for 36 cancers in 185 countries[J]. CA Cancer J Clin,2018,68(6):394-424.
2
Zeng H,Chen W,Zheng R,et al. Changing cancer survival in china during 2003-15:a pooled analysis of 17 population-based cancer registries[J]. Lancet Glob Health,2018,6(5):555-567.
33
Law S,Wong J. Two-field dissection is enough for esophageal cancer[J]. Dis Esophagus,2001,14(2):98-103.
34
Shao L,Ye T,Ma L,et al. Three-field versus two-field lymph node dissection for thoracic esophageal squamous cell carcinoma:a propensity score-matched comparison[J]. J Surg Oncol,2018,10(5):2924-2932.
35
刘孝民,王亚格,肖中岳. 微创及传统开放食管癌根治术疗效分析及远期随访结果的Meta分析[J]. 重庆医学,2017,46(2):1638-1647.
36
Ye T,Sun Y,Zhang Y,et al. Three-field or two-field resection for thoracic esophageal cancer:a meta-analysis[J]. Ann Thorac Surg,2013,96(6):1933-1941.
37
方文涛,陈文虎,陈勇,等. 选择性颈胸腹三野淋巴结清扫治疗胸段食管鳞状细胞癌[J]. 中华胃肠外科杂志,2006,9(5):388-391.
38
段孝凤,高晓旭,顾宪文. 序贯三切口及选择性淋巴结清扫治疗食管癌1162例临床效果分析[J]. 肿瘤研究与临床,2014,26(6):381-385.
39
Leng XF,Zhu Y,Wang GP,et al. Accuracy of ultrasound for the diagnosis of cervical lymph node metastasis in esophageal cancer:a systematic review and metaanalysis[J]. J Thorac Dis,2016,8(8):2146-2157.
40
方文涛,张展华,陈文虎,等. 颈部超声评价胸段食管癌颈部淋巴结转移[J].中华外科杂志,2003,41(7):523-525.
41
陈晓辉,柳硕岩,吴周贵. 彩超检查对食管癌颈部淋巴结转移的诊断价值[J].福建医药杂志,2009,31(3):108-110.
42
马长辉. 彩色多普勒超声与磁共振成像在诊断食管癌颈部转移淋巴结价值的临床研究[D]. 南京:南京医科大学,2017.
43
顾雅佳,王玖华,相加庆,等. CT观察胸段食管癌气管食管沟淋巴结转移的临床意义探讨[J]. 中华放射学杂志,2006,36(2):139-141.
44
刘戬. 薄层螺旋增强CT诊断胸段食管癌淋巴结转移的价值及胸段食管癌淋巴结转移规律探究[D]. 北京:中国医学科学院肿瘤医院,2012.
45
张倩倩. MSCT增强扫描对胸段食管癌淋巴结转移诊断标准及其规律的研究[D]. 济南:津南大学,2013.
46
Goense L,Meziani J,Van Rossum PSN,et al. Limited additional value of cervical ultrasonography over a negative 18F-FDG PET/CT for diagnosing cervical lymph node metastases in patients with esophageal cancer:a systematic review and meta-analysis[J]. Nucl Med Commun,2018,39(7):645-651.
47
陈少兴. 18F-FDG PET/CT代谢参数与食管癌淋巴结转移的相关性研究[D]. 福州:福建医科大学,2017.
48
Blom RL,Vliegen RF,Schreurs WM,et al. External ultrasonography of the neck does not add diagnostic value to integrated positron emission tomography-computed tomography(PET-CT)scanning in the diagnosis of cervical lymph node metastases in patients with esophageal carcinoma[J]. Dis Esophagus,2012,25(6):555-559.
49
Kratochwil C,Flechsig P,Lindner T, et al. Ga-FAPI PET/CT:Tracer uptake in 28 different kinds of cancer[J]. J Nucl Med,2019,60(6):801-805.
50
MacMahon H,Naidich DP,Goo JM,et al. Guidelines for management of incidental pulmonary nodules detected on CT images:from the fleischner society 2017[J]. Radiology,2017,284(1):228-243.
51
邵华飞,刘剑芳,姚丽波,等. 探讨Bayes判别分析在食管癌淋巴结转移CT诊断中的价值[J]. 放射学实践,2015,30(8):835-837.
52
刘奇. 胸段食管癌喉返神经旁淋巴结转移预测模型的建立[D]. 郑州:郑州大学,2017.
53
贾如真. 表浅型食管癌与早期胃癌淋巴结转移危险因素分析及预测模型[D]. 济南:山东大学医学院,2018.
54
谭显政. 基于CT影像组学精准预测可切除性食管鳞状细胞癌淋巴结转移和无病生存期[D]. 广州:南方医科大学,2016.
55
Qu J,Shen C,Qin J,et al. The MR radiomic signature can predict preoperative lymph node metastasis in patients with esophageal cancer[J]. Eur Radiol,2019,29(2):906-914.
[1] 栾梦琪, 夏蜀珺, 林琳, 张桂萍, 詹维伟. 超声引导下细针穿刺洗脱液测定 BRAF V600E突变丰度预测甲状腺乳头状癌颈部淋巴结转移[J]. 中华医学超声杂志(电子版), 2021, 18(09): 828-833.
[2] 张雨康, 何文, 万芳, 广旸. 多模态超声对甲状腺微小乳头状癌颈部淋巴结转移的预测价值[J]. 中华医学超声杂志(电子版), 2021, 18(09): 834-840.
[3] 段彤彤, 李晓琴, 范光磊, 施燕芸. 三阴性乳腺癌超声表现及其腋下淋巴结转移的相关危险因素[J]. 中华医学超声杂志(电子版), 2021, 18(04): 381-385.
[4] 赵敬柱, 郑向前, 高明, 赵金坤, 魏松锋, 运新伟, 池嘉栋. 甲状腺乳头状癌上纵隔淋巴结转移的诊治思考:附2例报告及文献复习[J]. 中华普通外科学文献(电子版), 2021, 15(04): 293-297.
[5] 许思哲, 贺功建, 曾黎, 杨蕙嘉, 王芳. 超声联合肿瘤标记物对cN0期甲状腺微小乳头状癌中央区淋巴结隐匿性转移的预测价值[J]. 中华普外科手术学杂志(电子版), 2021, 15(03): 314-318.
[6] 吴元清, 林杰, 罗佳宝, 邱堃, 黄平. 甲状腺微小乳头状癌淋巴结转移和腺外侵犯的危险因素分析[J]. 中华普外科手术学杂志(电子版), 2021, 15(03): 319-322.
[7] 卢振权, 罗兵锋, 李佩丰, 袁渊, 邢亚平, 罗琳, 王艳, 贾亦真, 侯健, 梁松武, 季瑞东, 罗光彦, 朱逸飞. 基于多参数磁共振建立前列腺穿刺活检预测模型[J]. 中华腔镜泌尿外科杂志(电子版), 2021, 15(04): 275-279.
[8] 陈波, 张科, 于明帅, 马荷荷. 腹部手术患者术后肺部并发症风险预测模型构建[J]. 中华肺部疾病杂志(电子版), 2021, 14(04): 502-504.
[9] 粟宇, 黄其密, 吕金莎. 食道支架置入术后合并肺部感染51例临床特征分析[J]. 中华肺部疾病杂志(电子版), 2021, 14(04): 527-529.
[10] 林琼真, 胡子良, 周戈, 林英. CT特征对肺腺癌患者间隙转移风险模型的构建分析[J]. 中华肺部疾病杂志(电子版), 2021, 14(03): 308-311.
[11] 李明东, 谢红强, 陶涛, 朱萧. 结直肠癌患者术后肠梗阻发生风险列线图预测模型的构建及评估[J]. 中华消化病与影像杂志(电子版), 2021, 11(04): 158-163.
[12] 苏欣宇, 严研, 姜倩, 夏建洪. 食管癌为第一原发癌的双原发癌患者预后分析[J]. 中华消化病与影像杂志(电子版), 2021, 11(03): 121-125.
[13] 周之伟, 王亮, 杨剑逸, 黄淼, 马则铭, 杨跃. 吻合口加固缝合对食管癌根治术后吻合口瘘发生的预防效果[J]. 中华临床医师杂志(电子版), 2021, 15(06): 407-411.
[14] 汪帅, 李红玲. 中性粒细胞/淋巴细胞比值、纤维蛋白原在食管癌诊断中的价值[J]. 中华临床医师杂志(电子版), 2021, 15(05): 365-369.
[15] 张嘉伟, 王健生, 张广健, 付军科, 屈航英, 张佳. 食管吻合口瘘动物模型研究进展[J]. 中华胸部外科电子杂志, 2021, 08(02): 101-107.
阅读次数
全文


摘要