Lagarde S M, Cense H A, Hulscher J B F, Tilanus H W, Ten Kate F J W, Obertop H, van Lanschot J J B
Department of Surgery, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands.
Br J Surg. 2005 Nov;92(11):1404-8. doi: 10.1002/bjs.5138.
The extent to which adenocarcinoma of the cardia with lymph node metastasis in the upper mediastinum is amenable to cure by radical surgery is open to debate. It remains unclear whether these relatively distant metastases have an effect on long-term survival. The aim of this study was to identify the incidence of such positive nodes and evaluate their prognostic significance.
Some 50 patients with adenocarcinoma of the gastric cardia and substantial invasion of the oesophagus (junctional type II), who underwent an extended transthoracic oesophagectomy as part of a prospective randomized trial between 1994 and 2000, were studied.
Eleven patients (22 per cent) had lymph node metastasis in the proximal field of the chest. These patients had more positive nodes overall (P = 0.020) and a shorter median survival (P = 0.009) than those without such metastasis. Multivariate analysis identified positive nodes in the proximal field as an independent predictor of poor survival.
Lymph node metastasis in the proximal field of the chest is common and is an indicator of poor prognosis in patients with adenocarcinoma of the cardia.
上纵隔淋巴结转移的贲门腺癌通过根治性手术治愈的程度尚有争议。这些相对远处的转移是否会影响长期生存仍不清楚。本研究的目的是确定此类阳性淋巴结的发生率并评估其预后意义。
对1994年至2000年间作为前瞻性随机试验一部分接受扩大经胸食管切除术的约50例胃贲门腺癌且食管有明显侵犯（交界型II）的患者进行了研究。
11例患者（22%）在胸部近端区域有淋巴结转移。与无此类转移的患者相比，这些患者总体上有更多的阳性淋巴结（P = 0.020）且中位生存期更短（P = 0.009）。多变量分析确定胸部近端区域的阳性淋巴结是生存不良的独立预测因素。
胸部近端区域的淋巴结转移很常见，是贲门腺癌患者预后不良的一个指标。
