Endo M, Yoshino K, Kawano T, Nagai K, Inoue H
Department of Surgery, Tokyo Medical and Dental University 1-5-45, Yushima, Bunkyo-ku, Tokyo 113-8519, Japan.
Dis Esophagus. 2000;13(2):125-9. doi: 10.1046/j.1442-2050.2000.00100.x.
We examined lymph node metastasis clinicopathologically in 236 cases of superficial cancer (T1, Tis) of the thoracic esophagus surgically resected at our department without adjuvant treatment. Mucosal cancer was observed in 112 cases (47%) and submucosal cancer in 124 cases (53%). Lymph node metastasis was present in 3% of mucosal cancer cases and 41% of submucosal cancer cases. By the recent pathologic subclassification of the extent of the cancerous invasion in superficial esophageal cancer, mucosal cancer and submucosal cancer were each divided into three subtypes according to the extent of invasion, i.e. m1, m2, m3, sm1, sm2 and sm3 cancers. There was no case of lymph node metastasis in m1 and m2 cases, but it was observed in 8% of m3 cases, in 11% of sm1 cases, in 30% of sm2 cases and in 61% of sm3 cases. The number of involved nodes was three or less in m3 and sm1 cases, however four or more involved nodes were observed in 14% of sm2 cases and in 24% of sm3 cases. Positive lymph nodes were found only in the mediastinum in m3 and sm1 cases. On the contrary, they were found extensively in the mediastinum, the abdomen and the neck and in two or more regions in 27% of sm2 cases and in 38% of sm3 cases. Considering the location of positive nodes, the recurrent nerve lymph nodes were most frequently involved, followed by the cardiac lymph nodes. A similar tendency was observed in cases with single node metastasis. The 5-year survival rate of cases from m1 to sm1 was similar. That of sm3 cases was significantly worse than that of other groups. Based on the clinical results, the therapeutic guidelines for superficial cancer of the thoracic esophagus are considered to be as follows: (i) in m1 and m2 cancer, endoscopic mucosal resection is generally indicated in principle, although transhiatal esophagectomy may be indicated in some cases; (ii) in m3 and sm1 cancer, endoscopic mucosal resection is performed initially, then subsequent treatment is selected if necessary; (iii) in sm2 and sm3 cancer, conventional transthoracic esophagectomy with systematic lymph node dissection is indicated.
我们对在我院接受手术切除且未进行辅助治疗的236例胸段食管浅表癌（T1、Tis）患者的淋巴结转移情况进行了临床病理检查。其中，黏膜癌112例（47%），黏膜下癌124例（53%）。黏膜癌患者中淋巴结转移率为3%，黏膜下癌患者中淋巴结转移率为41%。根据近期食管浅表癌癌浸润范围的病理亚分类，黏膜癌和黏膜下癌均根据浸润范围分为三个亚型，即m1、m2、m3癌以及sm1、sm2和sm3癌。m1和m2病例均未出现淋巴结转移，但m3病例中8%出现淋巴结转移，sm1病例中11%出现淋巴结转移，sm2病例中30%出现淋巴结转移，sm3病例中61%出现淋巴结转移。m3和sm1病例中受累淋巴结数量为3个及以下，但sm2病例中有14%、sm3病例中有24%出现4个及以上受累淋巴结。m3和sm1病例中仅在纵隔发现阳性淋巴结。相反，sm2病例中有27%、sm3病例中有38%在纵隔、腹部和颈部广泛发现阳性淋巴结，且在两个或更多区域出现。考虑到阳性淋巴结的位置，喉返神经淋巴结最常受累，其次是贲门淋巴结。单淋巴结转移病例也观察到类似趋势。m1至sm1病例的5年生存率相似。sm3病例的5年生存率明显低于其他组。基于临床结果，胸段食管浅表癌的治疗指南如下：（i）对于m1和m2癌，原则上一般建议行内镜黏膜切除术，不过在某些情况下可能需要行经裂孔食管切除术；（ii）对于m3和sm1癌，先进行内镜黏膜切除术，然后根据需要选择后续治疗；（iii）对于sm2和sm3癌，建议行传统经胸食管切除术并进行系统性淋巴结清扫。
