胸段食管鳞癌淋巴结转移规律及其对放疗临床靶区的影响：1077 例报告。

Pattern of lymph node metastases and its implication in radiotherapeutic clinical target volume in patients with thoracic esophageal squamous cell carcinoma: A report of 1077 cases.

机构信息

Department of Radiation Oncology (Chest Section), Shandong Cancer Institute (Hospital), Jinan, Shandong Province, PR China.

出版信息

Radiother Oncol. 2010 May;95(2):229-33. doi: 10.1016/j.radonc.2010.01.006. Epub 2010 Feb 25.

DOI:10.1016/j.radonc.2010.01.006

PMID:20189259

Abstract

PURPOSE

To study the pattern of lymph node metastases after esophagectomy and clarify the clinical target volume (CTV) delineation of thoracic esophageal squamous cell carcinoma (ESCC).

METHODS AND MATERIALS

Total 1077 thoracic ESCC patients who had undergone esophagectomy and lymphadenectomy were retrospectively examined. The clinicopathologic factors related to lymph node metastasis were analyzed using logistic regression analysis.

RESULTS

The rates of lymph node metastases in patients with upper thoracic tumors were 16.7% (9/54) cervical, 38.9% (18/54) upper mediastinal, 11.1% (6/54) middle mediastinal, 5.6% (3/54) lower mediastinal, and 5.6% (3/54) abdominal, respectively. The rates of lymph node metastases in patients with middle thoracic tumors were 4.0% (27/680), 3.8% (26/680), 32.9% (224/680), 7.1% (48/680), and 17.1% (116/680), respectively. The rates of lymph node metastases in patients with lower thoracic tumors were 1.0% (5/343), 3.0% (10/343), 22.7% (78/343), 37.0% (127/343), and 33.2% (114/343), respectively. T stage, the length of tumor and the histological differentiation emerged as statistically significant risk factors of lymph node metastases of thoracic ESCC (P < 0.001).

CONCLUSIONS

T stage, the length of tumor and the histologic differentiation influence the pattern of lymph node metastases in thoracic ESCC. These factors should be considered comprehensively to design the CTV for radiotherapy (RT) of thoracic ESCC. Selective regional irradiation including the correlated lymphatic drainage regions should be performed as well.

摘要

目的

研究食管癌根治术后淋巴结转移的模式，明确胸段食管鳞癌（ESCC）的临床靶区（CTV）勾画。

方法和材料

回顾性分析了 1077 例接受食管癌根治术和淋巴结清扫术的胸段 ESCC 患者。采用 logistic 回归分析与淋巴结转移相关的临床病理因素。

结果

上胸段肿瘤患者的淋巴结转移率分别为：颈段 16.7%（9/54），上纵隔 38.9%（18/54），中纵隔 11.1%（6/54），下纵隔 5.6%（3/54），腹段 5.6%（3/54）。中胸段肿瘤患者的淋巴结转移率分别为：4.0%（27/680），3.8%（26/680），32.9%（224/680），7.1%（48/680），17.1%（116/680）。下胸段肿瘤患者的淋巴结转移率分别为：1.0%（5/343），3.0%（10/343），22.7%（78/343），37.0%（127/343），33.2%（114/343）。T 分期、肿瘤长度和组织学分化是胸段 ESCC 淋巴结转移的统计学显著危险因素（P<0.001）。