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食管癌根治术后 2 野淋巴结清扫术治疗后食管鳞癌患者颈部淋巴结复发的结果。

Outcomes of cervical lymph node recurrence in patients with esophageal squamous cell carcinoma after esophagectomy with 2-field lymph node dissection.

机构信息

Division of Thoracic Surgery, Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.

出版信息

J Thorac Cardiovasc Surg. 2013 Aug;146(2):365-71. doi: 10.1016/j.jtcvs.2013.01.043. Epub 2013 Feb 17.

Abstract

OBJECTIVE

The purpose of this study is to investigate the clinical characteristics, prognosis, and risk factors of patients in whom cervical lymph node cancer recurred after esophageal cancer surgery with 2-field lymph node dissection.

METHODS

Between 2000 and 2010, 471 consecutive patients who had undergone esophagectomy with 2-field lymph node dissection for esophageal squamous cell carcinoma were enrolled in this study.

RESULTS

Recurrence was seen in 96 patients. Isolated cervical lymph node recurrence (group A) developed in 21 patients, locoregional recurrence only and without cervical lymph node recurrence (group B) in 29, and distant recurrence with or without locoregional recurrence (group C) in 46 patients. The median times to recurrence after surgery in groups A, B, and C were 20, 16, and 12 months, respectively (P = .634). 2- and 5-year rates of isolated cervical lymph node recurrence were 4.1% and 5.6%, respectively. The median survival times from diagnosis of recurrence were 13, 7, and 5 months in groups A, B, and C, respectively. The difference in survival between groups A and C was statistically significant (P = .030). Upper thoracic esophageal cancer and positive recurrent laryngeal node at the time of initial surgery were independent risk factors for cervical recurrence-free survival as determined by univariate and multivariate analysis.

CONCLUSIONS

This study shows that 2-field lymph node dissection can be performed with an acceptable rate of cervical lymph node recurrence. Patients with isolated cervical lymph node recurrence demonstrated longer survival from diagnosis of recurrence than patients with other sites of recurrence.

摘要

目的

本研究旨在探讨行 2 野淋巴结清扫的食管癌术后发生颈淋巴结转移患者的临床特征、预后及危险因素。

方法

2000 年至 2010 年,共纳入 471 例接受 2 野淋巴结清扫的食管鳞癌患者。

结果

96 例患者出现复发。21 例为单纯颈淋巴结复发(A 组),29 例为局部区域复发且无颈淋巴结转移(B 组),46 例为远处转移伴或不伴局部区域复发(C 组)。A、B、C 组患者术后复发的中位时间分别为 20、16 和 12 个月(P =.634)。2 年和 5 年单纯颈淋巴结复发率分别为 4.1%和 5.6%。A、B、C 组患者从复发诊断开始的中位生存时间分别为 13、7 和 5 个月。A 组和 C 组患者的生存差异有统计学意义(P =.030)。单因素和多因素分析显示,上胸段食管癌和初始手术时阳性的喉返神经淋巴结是颈淋巴结无复发生存的独立危险因素。

结论

本研究表明,2 野淋巴结清扫可导致可接受的颈淋巴结复发率。与其他部位复发的患者相比,单纯颈淋巴结复发的患者从复发诊断开始的生存时间更长。

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