食管胃交界部癌胸腔纵隔及腹腔淋巴结转移的危险因素
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摘要
目的探讨食管胃交界部癌(carcinoma of esophagogastric junction,CEJ)发生腹腔及胸腔纵隔淋巴结转移的危险因素,以指导是否清扫胸腔纵隔淋巴结。方法采用回顾性研究分析行食管胃交界部癌根治术的217例患者,分析术前胃镜及术后病理检查结果。结果淋巴结转移阳性数目是发生胸腔纵隔淋巴结转移独立的危险因素,且淋巴结转移数目每增加1个,纵隔淋巴结发生转移风险增加34.0%(OR=1.340,95%CI:1.090~1.648;P=0.006);脉管瘤栓(OR=5.83,95%CI:1.65~20.62,P=0.006)、浸润深度T(OR=2.35,95%CI:1.30~4.24,P=0.005)和上侵食管长度(OR=1.29,95%CI:1.02~1.63,P=0.033)是发生腹腔淋巴结转移的独立危险因素,而且上侵及食管每增加1 cm,发生腹腔淋巴结转移的风险增加29.0%。结论浸润深度越深、存在脉管瘤栓且上侵及食管越多的食管胃交界部癌患者发生腹腔淋巴结转移的风险越高。淋巴结转移数目越多,纵隔淋巴结发生转移的风险加大。
Objective To explore the risk factors of abdominal and thoracic mediastinal lymph node metastasis in carcinoma of esophagogastric junction( CEJ) and provide guidance for the necessity of mediastinal lymph node dissection.Methods Two-hundred-and-seventeen patients who have received CEJ radical resection were enrolled. The results of their pre-operative gastroscope test and post-operative pathological examination were analyzed. Results The number of metastatic lymph nodes was an independent risk factor for the occurrence of mediastinal lymph node metastasis. Moreover,as the number of metastatic lymph nodes increased by one,the risk of mediastinal lymph node metastasis increased by 34. 0%( OR = 1. 340,95% CI: 1. 090-1. 648,P = 0. 006). Besides,the carcinoma cell embolus( OR = 5. 83,95% CI:1. 65-20. 62,P = 0. 006),the invasion depth T( OR = 2. 35,95% CI: 1. 30-4. 24,P = 0. 005),and the length of esophageal invasion( OR = 1. 29,95% CI: 1. 02-1. 63,P = 0. 033) were all independent risk factors for abdominal lymph node metastasis. As the length of esophageal invasion increased by 1 cm,the risk of abdominal lymph node metastasis increased by 29. 0%. Conclusions CEJ patients who have deeper tumor invasion,more carcinoma cell embolus and longer esophageal invasion are prone to have a higher rate of abdominal lymph node metastasis. Moreover,the risk of mediastinal lymph node metastasis increased as the number of metastatic lymph nodes increased.
Objective To explore the risk factors of abdominal and thoracic mediastinal lymph node metastasis in carcinoma of esophagogastric junction( CEJ) and provide guidance for the necessity of mediastinal lymph node dissection.Methods Two-hundred-and-seventeen patients who have received CEJ radical resection were enrolled. The results of their pre-operative gastroscope test and post-operative pathological examination were analyzed. Results The number of metastatic lymph nodes was an independent risk factor for the occurrence of mediastinal lymph node metastasis. Moreover,as the number of metastatic lymph nodes increased by one,the risk of mediastinal lymph node metastasis increased by 34. 0%( OR = 1. 340,95% CI: 1. 090-1. 648,P = 0. 006). Besides,the carcinoma cell embolus( OR = 5. 83,95% CI:1. 65-20. 62,P = 0. 006),the invasion depth T( OR = 2. 35,95% CI: 1. 30-4. 24,P = 0. 005),and the length of esophageal invasion( OR = 1. 29,95% CI: 1. 02-1. 63,P = 0. 033) were all independent risk factors for abdominal lymph node metastasis. As the length of esophageal invasion increased by 1 cm,the risk of abdominal lymph node metastasis increased by 29. 0%. Conclusions CEJ patients who have deeper tumor invasion,more carcinoma cell embolus and longer esophageal invasion are prone to have a higher rate of abdominal lymph node metastasis. Moreover,the risk of mediastinal lymph node metastasis increased as the number of metastatic lymph nodes increased.
引文
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[16]张志宏,李良平,刘晓岗,等.不同内镜方式判断早期食管癌浸润深度准确性的对比研究[J].中华消化内镜杂志,2017,34(3):43-48.
[17]De Manzoni G,Pedrazzani C,Pasini F,et al.Results of surgical treatment of adenocarcinoma of the gastric cardia[J].Ann Thorac Surg,2002,73(4):1035-1040.
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[19]Kakeji Y,Yamamoto M,Ito S,et al.Lymph node metastasis from cancer of the esophagogastric junction,and determination of the appropriate nodal dissection[J].Surg Today,2012,42(4):351-358.
[20]原超,范宗民,陈曦,等.淋巴结切除总数及阳性转移个数对贲门癌患者术后生存期的影响[J].郑州大学学报(医学版),2012,47(5):595-597.
[21]Barbour AP,Rizk NP,Gonen M,et al.Lymphadenectomy for adenocarcinoma of the gastroesophageal junction(GEJ):impact of adequate staging on outcome[J].Ann Surg Oncol,2007,14(2):306-316.
[2]Liu K,Yang K,Zhang W,et al.Changes of esophagogastric junctional adenocarcinoma and gastroesophageal reflux disease among surgical patients during 1988-2012:A single-institution,high-volume experience in China[J].Ann Surg,2016,263(1):88-95.
[3]Siewert JR,Holscher AH,Becker K,et al.Cardia cancer:attempt at a therapeutically relevant classification[J].Chirurg,1987,58(1):25-32.
[4]Engstrom PF,Arnoletti JP,Benson AB,et al.NCCN Clinical Practice Guidelines in Oncology:rectal cancer[J].J Natl Compr Canc Netw,2009,7(8):838-881.
[5]Japan Esophageal Society.Japanese classification of esophageal cancer,tenth edition:partsⅡandⅢ[J].Esophagus,2009,6(1):71-94.
[6]Rice TW,Blackstone EH,Ruseh VW.7th edition of the AJCC cancer staging manual:esophagus and esophagogastric junction[J].Ann Surg Oncol,2010,17(7):1721-1724.
[7]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.
[8]Sasako M,Sano T,Yamamoto S,et al.Left thoracoabdominal approach versus abdominal-transhiatal approach for gastric cancer of the cardia or subcardia:a randomised controlled trial[J].Lancet Oncol,2006,7(8):644-651.
[9]Lagarde SM,Reitsma JB,Ten KFJ,et al.Predicting individual survival after potentially curative esophagectomy for adenocarcinoma of the esophagus or gastroesophageal junction[J].Ann Surg,2008,248(6):1006-1013.
[10]Liu K,Zhang W,Chen X,et al.Comparison on clinicopathological features and prognosis between esophagogastric junctional adenocarcinoma(SiewertⅡ/Ⅲtypes)and distal gastric adenocarcinoma:Retrospective cohort study,a single institution,high volume experience in China[J].Medicine(Baltimore),2015,94(34):e1386.
[11]Mattioli S,Ruffato A,Di Simone MP,et al.Immunopathological patterns of the stomach in adenocarcinoma of the esophagus,cardia,and gastric antrum:gastric profiles in Siewert typeⅠandⅡtumors[J].Ann Thorac Surg,2007,83(5):1814-1819.
[12]方文涛.食管胃交界部腺癌手术入路与淋巴结清扫[J].中华胃肠外科杂志,2010,13(9):646-648.
[13]Cense HA,Sloof GW,Klaase JM,et al.Lymphatic drainage routes of the gastric cardia visualized by lymphoscintigraphy[J].J Nucl Med,2004,45(2):247-252.
[14]Gertler R,Stein HJ,Schuster T,et al.Prevalence and topography of lymph node metastases in early esophageal and gastric cancer[J].Ann Surg,2014,259(1):96-101.
[15]Grotenhuis BA,Wijnhoven BP,van Marion R,et al.The sentinel node concept in adenocarcinomas of the distal esophagus and gastroesophageal junction[J].J Thorac Cardiovasc Surg,2009,138(3):608-612.
[16]张志宏,李良平,刘晓岗,等.不同内镜方式判断早期食管癌浸润深度准确性的对比研究[J].中华消化内镜杂志,2017,34(3):43-48.
[17]De Manzoni G,Pedrazzani C,Pasini F,et al.Results of surgical treatment of adenocarcinoma of the gastric cardia[J].Ann Thorac Surg,2002,73(4):1035-1040.
[18]Hosokawa Y,Kinoshita T,Konishi M,et al.Clinicopathological features and prognostic factors of adenocarcinoma of the esophagogastric junction according to Siewert classification:experiences at a single institution in Japan[J].Ann Surg Oncol,2012,19(2):677-683.
[19]Kakeji Y,Yamamoto M,Ito S,et al.Lymph node metastasis from cancer of the esophagogastric junction,and determination of the appropriate nodal dissection[J].Surg Today,2012,42(4):351-358.
[20]原超,范宗民,陈曦,等.淋巴结切除总数及阳性转移个数对贲门癌患者术后生存期的影响[J].郑州大学学报(医学版),2012,47(5):595-597.
[21]Barbour AP,Rizk NP,Gonen M,et al.Lymphadenectomy for adenocarcinoma of the gastroesophageal junction(GEJ):impact of adequate staging on outcome[J].Ann Surg Oncol,2007,14(2):306-316.