*Chirurgische Klinik und Poliklinik †Klinik für Allgemein-, Viszeral- und Thoraxchirurgie, Klinikum Nürnberg Nord, Nürnberg, Germany ‡Institut für Medizinische Statistik und Epidemiologie; and §Institut für Allgemeine Pathologie und Pathologische Anatomie, Klinikum rechts der Isar, Technische Universität München, Munich, Germany.
Ann Surg. 2014 Jan;259(1):96-101. doi: 10.1097/SLA.0000000000000239.
To determine the prevalence and localization of lymph node metastases in patients with pT1 carcinoma of the esophagus, esophagogastric junction, and stomach.
Retrospective analysis and topographic description.
We included 793 consecutive patients with pT1 carcinomas who underwent primary surgery for squamous cell carcinoma (SCC) of the esophagus, adenocarcinomas of the esophagogastric junction (AEG), or gastric cancer (GC). Clinical records and pathology reports were reviewed, and the prevalence and topography of lymph node metastases were identified.
The prevalence of lymph node metastases in SCC, AEG, and GC was 7%, 0%, and 5% for pT1a tumors and 24%, 18%, and 14% for pT1b tumors, respectively. Positive lymph node status was associated with worse overall survival (P<0.001). Not only infiltration of the submucosa (P=0.002) but also lymphatic vessel invasion (P<0.001), multifocal tumor growth (P=0.001), lower patient age (P=0.001), and poor tumor differentiation (P=0.05) were associated with nodal disease. These 5 parameters allowed the compilation of a nomogram to estimate the individual risk of lymph node metastases. In SCC, lymph node metastases were found from the neck to the celiac axis. In AEG, nodal disease was limited to the lower mediastinum and the D1 compartment. In GC, lymphatic spread exceeded the D1 compartment in 7% of node positive patients.
Risk estimation for lymph node metastases should not be based on depth of tumor infiltration alone but additional clinicopathological parameters should also be considered. The extent of lymphadenectomy in surgical procedures should respect the presented topography of lymph node metastases.
确定食管、食管胃交界部和胃的 pT1 癌患者的淋巴结转移的发生率和定位。
回顾性分析和描述性研究。
我们纳入了 793 例接受原发性手术治疗的 pT1 食管癌、食管胃交界部腺癌和胃癌患者。回顾临床记录和病理报告，确定淋巴结转移的发生率和定位。
pT1a 肿瘤中 SCC、AEG 和 GC 的淋巴结转移率分别为 7%、0%和 5%，pT1b 肿瘤分别为 24%、18%和 14%。阳性淋巴结状态与总体生存不良相关（P<0.001）。不仅黏膜下浸润（P=0.002），还有淋巴管浸润（P<0.001）、多灶性肿瘤生长（P=0.001）、患者年龄较小（P=0.001）和肿瘤分化不良（P=0.05）与淋巴结疾病相关。这 5 个参数可用于编制列线图以估计个体淋巴结转移的风险。在 SCC 中，淋巴结转移从颈部延伸至腹腔干。在 AEG 中，淋巴结疾病仅限于下纵隔和 D1 区。在 GC 中，7%的阳性淋巴结患者存在淋巴扩散超过 D1 区。
淋巴结转移的风险估计不应仅基于肿瘤浸润深度，还应考虑其他临床病理参数。手术中的淋巴结清扫范围应尊重所呈现的淋巴结转移的解剖定位。
