[根治性切除术后胸段食管鳞状细胞癌患者清扫淋巴结数量对生存的影响]

[Impact of number of dissected lymph nodes on survival in patients with thoracic esophageal squamous cell carcinoma after radical resection].

作者信息

Wang Y X, Wang L L, Yang Q, He M, Qi Z, Qiao X Y, Zhu S C

机构信息

Department of Radiation Oncology, Fourth Hospital of Hebei Medical University, Shijiazhuang 050011, China.

Department of Thoracic Surgery, Fourth Hospital of Hebei Medical University, Shijiazhuang, 050011, China.

出版信息

Zhonghua Zhong Liu Za Zhi. 2016 Feb;38(2):150-5. doi: 10.3760/cma.j.issn.0253-3766.2016.02.014.

DOI:10.3760/cma.j.issn.0253-3766.2016.02.014

PMID:26899337

Abstract

OBJECTIVE

To evaluate the impact of the number of dissected lymph nodes on survival of patients with stage T3N0M0 thoracic esophageal squamous cell carcinoma (ESCC).

METHODS

The clinicopathlogical dada of 249 patients with stage T3N0M0 thoracic ESCC were analyzed retrospectively. The median age of the 249 patients (171 males and 78 females) was 60-year old. The primary lesions were located in the upper- in 40, middle- in 177, and lower-thoracic esophagus in 45 patients. The median length of the lesions was 5 cm (range 2-12 cm). As for the severity of adhesion after surgery, there were 35 with no adhesion, 90 with mild-, and 124 patients with severe adhesion. The median number of dissected lymph nodes (dissected LN) at surgery was 9 (range 1-27), among them, less than 6 dissected LNs in 55, 6-11 dissected LNs in 133, and 11 or more dissected LNs in 61 cases. There were 210 patients with moderately or highly, and 39 with poorly differentiated cancer. 98 patients were treated with surgery alone, and 151 with postoperative adjuvant treatment.

RESULTS

The follow-up deadline was July 2013. The 1-, 3-, and 5-year overall survival rates were 90.0%, 68.7% and 55.2%, respectively. The 1-, 3-, and 5-year survival rates were 85.5%, 63.6% and 39.1% in patients with <6 dissected LNs, 89.5%, 67.7% and 56.9% in patients with 6-11 dissected LNs, and 95.1%, 75.4% and 66.2% in patients with >11 dissected LNs, respectively (P=0.073). The survival was shorter in patients with <6 dissected LNs than patients with >11 dissected LNs (P=0.022). The subgroup analysis showed that in patients with middle-thoracic ESCC, the length of lesion ≤5 cm or mild adhesion after surgery and the number of dissected LNs were associated with survival after surgery.

CONCLUSIONS

For patients with stage T3N0M0 thoracic ESCC after surgery, the number of dissected LNs is an important factor affecting the survival, and at least 6 or more lymph nodes should be dissected. If lymphadenectomy is not adequately performed, postoperative adjuvant therapy should be recommend.

摘要

目的

评估T3N0M0期胸段食管鳞状细胞癌（ESCC）患者清扫淋巴结数量对生存的影响。

方法

回顾性分析249例T3N0M0期胸段ESCC患者的临床病理资料。249例患者（男171例，女78例）中位年龄为60岁。原发灶位于胸段食管上段40例，中段177例，下段45例。病变中位长度为5cm（范围2 - 12cm）。术后粘连严重程度：无粘连35例，轻度粘连90例，重度粘连124例。手术清扫淋巴结（清扫LN）中位数量为9个（范围1 - 27个），其中清扫LN少于6个55例，6 - 11个133例，11个及以上61例。中高分化癌210例，低分化癌39例。单纯手术治疗98例，术后辅助治疗151例。

结果

随访截止至2013年7月。1年、3年和5年总生存率分别为90.0%、68.7%和55.2%。清扫LN少于6个患者的1年、3年和5年生存率分别为85.5%、63.6%和39.1%，清扫LN为6 - 11个患者分别为89.5%、67.7%和56.9%，清扫LN大于11个患者分别为95.1%、75.4%和66.2%（P = 0.073）。清扫LN少于6个的患者生存期短于清扫LN大于11个的患者（P = 0.022）。亚组分析显示，对于胸段食管中段ESCC患者，病变长度≤5cm或术后轻度粘连以及清扫LN数量与术后生存相关。