Zhang Y J, Wang J, Zhang X L, Liu Q, Jing S W, Wang Y, Cao F, Jiao W P
Department of Radiation Oncology, Fourth Hospital of Hebei Medical University, Shijiazhuang 050011, China.
Zhonghua Zhong Liu Za Zhi. 2016 Sep 23;38(9):672-6. doi: 10.3760/cma.j.issn.0253-3766.2016.09.007.
To explore the patterns and influencing factors of lymph node metastasis of adenocarcinoma of the esophagogastric junction (AEG).
Clinicopathological data of 393 AEG patients who underwent radical resection and lymphadenectomy in the thoracic or abdominal cavity were collected. We analyzed the metastatic patterns of 5 119 excised lymph nodes with an average of 13 nodes per patient according to Siewert classification, and the associations between lymphatic metastasis and clinicopathological factors, such as tumor invasion, differentiation, maximum diameter, or pathological type were analyzed.
The lymph node metastasis rate and ratio (LNR) were 70.0% (275/393) and 29.1% (1 492/5 119), respectively. All the Siewert subtypes of AEG mainly metastasize downwards to the abdominal lymph nodes, while also spread upwards to the mediastinal lymph nodes. Among them, the lymph node metastasis rate was highest in Siewert type Ⅰ and lowest in Siewert type Ⅲ AEG. The lymph node metastasis rate and ratio in T1, T2, T3, T4 AEGs were 0%, 29.4%, 75.0%, 74.6% and 0%, 10.1%, 14.2%, 32.0%, respectively (χ(2)=35.305, P<0.001 and χ(2)=134.034, P<0.001). The lymph node metastasis rate and ratio of the poorly differentiated adenocarcinoma were 36.0% and 79.3%, respectively, significantly higher than 22.1% and 61.7% of the well-differentiated adenocarcinoma (χ(2)=14.468, P<0.001 and χ(2)=120.009, P<0.001). The lymph node metastasis rate and ratio of patients with a tumor in maximum diameter ≥4 cm were 73.1% and 30.9%, significantly higher than 46.8% and 14.6%, respectively, in the patients with a tumor in maximum diameter of <4 cm (χ(2)=13.636, P<0.001 and χ(2)=64.767, P<0.001). The group of vascular tumor thrombus showed significantly higher lymph node metastasis rate and ratio than those in the group with no vascular tumor thrombus (84.6% versus 67.1%, χ(2)=7.946, P=0.005; and 45.0% versus 26.0%, χ(2)=112.723, P<0.001). The lymph node metastasis ratio of mucinous and signet ring cell adenocarcinoma was 34.9%, significantly higher than 28.5% of the adenocarcinoma (χ(2)=8.710, P<0.001) The depth of tumor invasion and degree of tumor differentiation were independent factors affecting lymph node metastasis (P=0.001 and P<0.001).
The lymph node metastasis rate and ratio of AEG are high and influenced by many clinicopathological factors. The patterns of lymph node metastasis are different among different Siewert subtype AEGs.The depth of tumor invasion and differentiation degree are independent factors affecting lymphatic metastasis.
探讨食管胃交界腺癌（AEG）淋巴结转移规律及影响因素。
收集393例行根治性切除及胸腹腔淋巴结清扫的AEG患者的临床病理资料。根据Siewert分型分析5119枚切除淋巴结的转移规律，平均每位患者13枚淋巴结，并分析淋巴结转移与肿瘤浸润、分化程度、最大径、病理类型等临床病理因素之间的关系。
淋巴结转移率及转移比值（LNR）分别为70.0%（275/393）和29.1%（1492/5119）。AEG的所有Siewert亚型主要向下转移至腹部淋巴结，同时也向上转移至纵隔淋巴结。其中，SiewertⅠ型AEG的淋巴结转移率最高，SiewertⅢ型AEG最低。T1、T2、T3、T4期AEG的淋巴结转移率及转移比值分别为0%、29.4%、75.0%、74.6%和0%、10.1%、14.2%、32.0%（χ²=35.305，P<0.001；χ²=134.034，P<0.001）。低分化腺癌的淋巴结转移率及转移比值分别为36.0%和79.3%，显著高于高分化腺癌的22.1%和61.7%（χ²=14.4,68，P<0.001；χ²=120.009，P<0.001）。最大径≥4cm肿瘤患者的淋巴结转移率及转移比值分别为73.1%和30.9%，显著高于最大径<4cm肿瘤患者的46.8%和14.6%（χ²=13.636，P<0.001；χ²=64.767，P<0.001）。血管内肿瘤血栓组的淋巴结转移率及转移比值显著高于无血管内肿瘤血栓组（84.6%对67.1%，χ²=7.946，P=0.005；45.0%对26.0%，χ²=112.723，P<0.001）。黏液腺癌和印戒细胞癌的淋巴结转移比值为34.9%，显著高于腺癌的28.5%（χ²=8.710，P<0.001）。肿瘤浸润深度和肿瘤分化程度是影响淋巴结转移的独立因素（P=0.001，P<0.001）。
AEG的淋巴结转移率及转移比值较高，受多种临床病理因素影响。不同Siewert亚型AEG的淋巴结转移规律不同。肿瘤浸润深度和分化程度是影响淋巴转移的独立因素。
