| 张海琛,朱冰楠,郑进,叶福秀,李先琴,石静滨.胸段食管鳞癌淋巴结转移规律及相关危险因素的临床研究[J].中华放射医学与防护杂志,2016,36(6):439-443 |
| 胸段食管鳞癌淋巴结转移规律及相关危险因素的临床研究 |
| Clinical study on the pattern and the risk factors of lymph node metastasis of thoracic esophageal squamous cell carcinoma |
| 投稿时间：2015-11-16 |
| DOI：10.3760/cma.j.issn.0254-5098.2016.06.008 |
| 中文关键词: 食管癌 淋巴结转移 危险因素 |
| 英文关键词:Esophageal cancer Lymph node metastasis Risk factors |
| 基金项目: |
|
| 摘要点击次数: 2462 |
| 全文下载次数: 2102 |
| 中文摘要: |
| 目的 研究胸段食管鳞癌淋巴结转移规律及其相关危险因素,为食管癌患者放射治疗靶区的勾画提供理论依据。方法 回顾性分析大连医科大学附属二院手术切除的319例胸段食管鳞癌患者的临床病理资料。淋巴结分组按美国胸科协会(AST)修订的图谱,将食管区域淋巴结分为20组。探究淋巴结转移规律及其与发病部位、肿瘤长度、浸润深度、分化程度、脉管癌栓的关系,分析其相关的潜在危险因素。结果 319例胸段食管鳞癌患者的淋巴结转移率为48.90%(156/319),淋巴结转移度为15.70%(562/3581)。胸上、中、下段淋巴结转移率分别为35.48%、47.06%、56.43%,有从上而下逐渐增加的趋势,但差异无统计学意义(P>0.05),以胸下段为最高。20组淋巴结中胸上段1、2、4、5、7、9组的淋巴结转移度较高(χ2=27.38,P<0.05);胸中段2、4、5、7、8M组的淋巴结转移度较高(χ2=57.77,P<0.05);胸下段的4、5、7、8L、16、17、20组的淋巴结转移度较高(χ2=28.88,P<0.05)。因此,胸段食管鳞癌淋巴结转移的主要部位为食管旁、隆突下、气管旁、主肺动脉窗、胃左动脉旁、贲门旁和腹腔淋巴结。胸段食管鳞癌淋巴结转移与分化程度、病变长度、浸润深度、有无脉管癌栓有相关性(χ2=6.82、26.04、36.26、4.56,P<0.05),与性别、年龄、发病部位、切缘情况无相关性(P>0.05)。其中肿瘤病变长度、浸润深度是独立危险因素(OR=2.212、2.123,P<0.05)。结论 胸段食管鳞癌淋巴结转移与病变长度、浸润深度、分化程度、脉管癌栓有关,勾画靶区时应综合考虑以上相关因素进行个体化治疗。 |
| 英文摘要: |
| Objective This study was to investigate the lymph node metastasis pattern in thoracic esophageal squamous cell carcinoma (ESCC), and analyze the risk factors to provide reference for the delineation of radiotherapy target. Methods A total of 319 patients with thoracic ESCC who underwent surgical treatment at the second hospital of Dalian medical university were analyzed retrospectively. The lymph nodes around esophageal were divided into 20 groups according to the mapping scheme of the American Thoracic Society (ATS) modified by Casson et al. Analyzed the pattern of lymph node metastasis and its relationship with tumor location, tumor length, depth of invasion, pathological grade, and vessel invasion. Results The lymph node metastatic rate was 48.90% (156/319), while the metastatic ratio of lymph node (LMR) was 15.70% (562/3581). The lymph node metastatic rates had gradually increasing trend with tumor sites descending (upper ESCC 35.48%, middle ESCC 47.06% and lower ESCC 56.43%), but no statistically significance (P>0.05) was observed. In the whole 20 groups, the higher node metastasis stations of upper thoracic ESCC LMR were 1, 2, 4, 5, 7, 9(χ2=27.38, P<0.05), while the middle thoracic ESCC LMR were 2, 4, 5, 7, 8M(χ2=57.77, P<0.05), and the lower thoracic ESCC LMR were 4, 5, 7, 8L, 16, 17, 20(χ2=28.88, P<0.05),with statistically significance. So the main lymph node metastasis stations were paraesophageal nodes, tracheobronchial nodes, paratracheal nodes, aroticopumonary nodes, left gastric nodes, subcarinalnodes and celiac nodes. The univariate analysis revealed that lymph node metastasis was correlated with the tumor length, depth of invasion, pathological grade, and presence of vascular invasion (χ2=6.82, 26.04, 36.26, 4.56 respectively, P<0.05). The multi-variate regression analysis showed that tumor length and depth of tumor invasion were independent risk factors for lymph node metastasis (OR=2.212, 2.123, P<0.05). Conclusions The factors influencing lymph node metastasis in thoracic ESCC include tumor length, depth of invasion, pathological grade, and presence of vascular invasion, which should be carefully considered during the target delineation of radiotherapy for esophageal carcinoma. |
| HTML 查看全文 查看/发表评论 下载PDF阅读器 |
| 关闭 |
|
|
|