接受三野淋巴结清扫术治疗的临床I期胸段食管鳞状细胞癌患者的临床病理特征及生存情况
Clinicopathologic characteristics and survival of patients with clinical Stage I squamous cell carcinomas of the thoracic esophagus treated with three-field lymph node dissection.
作者信息
Igaki H, Kato H, Tachimori Y, Daiko H, Fukaya M, Yajima S, Nakanishi Y
机构信息
Department of Surgery, National Cancer Center Hospital and Research Institute,1-1 Tsukiji 5-chome, Chuo-ku, Tokyo, 104-0045, Japan.
出版信息
Eur J Cardiothorac Surg. 2001 Dec;20(6):1089-94. doi: 10.1016/s1010-7940(01)01003-x.
OBJECTIVE
Clinicopathologic characteristics and survival rates of patients with clinical Stage I tumors treated with three-field lymph node dissection have not been well investigated. This report documents the results of a series of cases of clinical Stage I squamous cell carcinomas treated with this surgical procedure in our institute.
METHODS
From January 1988 to March 1997, 326 patients with carcinomas of the thoracic esophagus underwent transthoracic esophagectomy with three-field lymph node dissection. Two hundred and ninety-seven (91%) of these had squamous cell carcinomas. Fifty-seven (18%) patients with clinical Stage I squamous cell carcinomas of the thoracic esophagus were retrospectively reviewed here.
RESULTS
Among 57 clinical Stage I squamous cell carcinomas, ten (18%) were diagnosed as T1-mucosal and 47 (83%) as T1-submucosal. Seventy percent of the patients with clinical T1-mucosal tumors had additional primary esophageal lesions. The operative morbidity and in-hospital mortality rates were 63 and 0%, and the overall 1-, 3-, 5-, and 10-year survival rates were 95, 86, 78, and 70%, respectively. Of the 57 tumors assessed pathologically, 12 (21%) were T1-mucosal, 42 (74%) were T1-submucosal, and three (5%) were T2. Nineteen (33%) exhibited lymph node metastasis. The 1-, 3-, 5-, and 10-year survival rates for patients with lymph node metastasis were 90, 79, 73, and 58%, respectively, as compared with 97, 90, 80, and 76, respectively for patients without lymph node metastasis (P=0.24). The accuracy of preoperative staging, based on both wall penetration and the status regarding lymph node metastasis, was 63%. With reference to the 1997 UICC-TNM staging system, 36 (63%) were pStage I, two (4%) were pStage IIA, 18 (28%) were pStage IIB, and three (6%) were pStage IVB. The 1-, 3-, 5-, and 10-year survival rates for patients with pStage I disease were 97, 92, 85, and 81%, respectively. In those with pStage II or IV disease, the values were 91, 76, 65, and 52%, respectively.
CONCLUSIONS
Three-field lymph node dissection may be indicated even for patients with clinical Stage I squamous cell carcinoma requiring surgical intervention because this surgical procedure provides for possible cure by removing unsuspected lymph node metastasis.
目的
对于接受三野淋巴结清扫术治疗的临床I期肿瘤患者的临床病理特征及生存率尚未进行充分研究。本报告记录了我院采用该手术方法治疗的一系列临床I期鳞状细胞癌病例的结果。
方法
1988年1月至1997年3月，326例胸段食管癌患者接受了经胸段食管切除术及三野淋巴结清扫术。其中297例（91%）为鳞状细胞癌。本文对57例（18%）胸段食管临床I期鳞状细胞癌患者进行了回顾性分析。
结果
在57例临床I期鳞状细胞癌中，10例（18%）被诊断为T1-黏膜型，47例（83%）为T1-黏膜下型。临床T1-黏膜型肿瘤患者中有70%存在其他原发性食管病变。手术并发症发生率和院内死亡率分别为63%和0%，1年、3年、5年和10年总生存率分别为95%、86%、78%和70%。在57例经病理评估的肿瘤中，12例（21%）为T1-黏膜型，42例（74%）为T1-黏膜下型，3例（5%）为T2型。19例（33%）出现淋巴结转移。有淋巴结转移患者的1年、3年、5年和10年生存率分别为90%、79%、73%和58%，而无淋巴结转移患者分别为97%、90%、80%和76%（P = 0.24）。基于壁层浸润和淋巴结转移情况的术前分期准确率为63%。参照1997年UICC-TNM分期系统，36例（占63%）为pI期，2例（占4%）为pIIA期，18例（占28%）为pIIB期，3例（占6%）为pIVB期。pI期疾病患者的1年、3年、5年和10年生存率分别为97%、92%、85%和81%。pII期或IV期疾病患者的相应生存率分别为91%、76%、65%和52%。
结论
对于需要手术干预的临床I期鳞状细胞癌患者，即使是该期患者也可考虑行三野淋巴结清扫术，因为这种手术方法有可能通过切除未被怀疑的淋巴结转移灶实现治愈。
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