Department of Thoracic Oncology, Cancer Center, Sun Yat-sen University, Guangzhou, People's Republic of China.
Ann Thorac Surg. 2012 Feb;93(2):423-7. doi: 10.1016/j.athoracsur.2011.10.011. Epub 2011 Dec 16.
Subcarinal node metastasis is common in patients with esophageal cancer. Some scholars have suggested that subcarinal nodes might not need to be sampled or dissected in patients with superficial squamous cell carcinoma of the thoracic esophagus. This research investigated the frequency of subcarinal node metastasis in patients with esophageal squamous cell carcinoma, identified the factors correlated to subcarinal node metastasis, and evaluated the clinical relevance of subcarinal node metastasis in thoracic esophageal squamous cell carcinoma.
We retrospectively analyzed the clinical data of 1,812 consecutive patients with thoracic esophageal squamous cell carcinoma who underwent esophagectomy in the Cancer Center of Sun Yat-sen University. The surgical procedures included the left transthoracic procedure, Ivor-Lewis approach, and the cervical-thoracoabdominal procedure.
The frequency of subcarinal node metastasis was 10.0%. The univariate and multivariate analysis showed that longer tumor length, higher pathologic T stage, lower histologic grade, and positive lymph node metastases of other groups were associated with a higher frequency of subcarinal node metastasis (all p<0.05). Patients with solitary subcarinal node metastasis had a significantly lower 5-year cumulative survival rate than those with solitary paraesophageal node metastasis (25.3% vs 39.6%, p<0.05).
Longer tumor length, higher pathologic T stage, lower histologic grade, and positive lymph node metastases of other groups are associated with a higher frequency of subcarinal node metastasis. Subcarinal node metastasis indicates worse prognosis of patients with thoracic esophageal squamous cell carcinoma compared with paraesophageal node metastasis.
食管鳞状细胞癌患者常发生隆突下淋巴结转移。一些学者认为，对于胸段食管浅表鳞癌患者，隆突下淋巴结可不进行采样或清扫。本研究旨在探讨食管鳞状细胞癌患者隆突下淋巴结转移的频率，明确与隆突下淋巴结转移相关的因素，并评估胸段食管鳞状细胞癌隆突下淋巴结转移的临床意义。
我们回顾性分析了中山大学肿瘤防治中心收治的 1812 例行食管癌切除术患者的临床资料。手术方式包括左开胸、经左颈胸腹三切口和经右胸两切口。
隆突下淋巴结转移的频率为 10.0%。单因素和多因素分析显示，肿瘤长度较长、病理 T 分期较高、组织学分级较低以及其他部位淋巴结阳性转移与隆突下淋巴结转移频率较高相关（均 P<0.05）。单一隆突下淋巴结转移患者的 5 年累积生存率明显低于单一食管旁淋巴结转移患者（25.3%比 39.6%，P<0.05）。
肿瘤长度较长、病理 T 分期较高、组织学分级较低以及其他部位淋巴结阳性转移与隆突下淋巴结转移频率较高相关。与食管旁淋巴结转移相比，隆突下淋巴结转移提示胸段食管鳞状细胞癌患者预后较差。
