胃食管结合部肿瘤淋巴结转移的定位：一项全国前瞻性多中心研究。

Mapping of Lymph Node Metastasis From Esophagogastric Junction Tumors: A Prospective Nationwide Multicenter Study.

机构信息

Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, Osaka, Japan.

Department of Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan.

出版信息

Ann Surg. 2021 Jul 1;274(1):120-127. doi: 10.1097/SLA.0000000000003499.

DOI:10.1097/SLA.0000000000003499

PMID:31404008

Abstract

OBJECTIVE

The aim of the study was to determine the optimal extent of lymph node dissection for the 2 histological types of esophagogastric junction (EGJ) tumors based on the incidence of metastasis in a prospective nationwide multicenter study.

BACKGROUND

Because most previous studies were retrospective, the optimal surgical procedure for EGJ tumors has not been standardized.

METHODS

Patients with cT2-T4 adenocarcinoma or squamous cell carcinoma located within 2.0 cm of the EGJ were enrolled before surgery. Surgeons dissected all lymph nodes prespecified in the protocol, using either the abdominal transhiatal or right transthoracic approach. The primary endpoint was the metastasis rate of each lymph node. Lymph nodes were classified according to metastasis rate, as follows: category-1 (strongly recommended for dissection), rate more than 10%; category-2 (weakly recommended for dissection), rate from 5% to 10%; and category-3 (not recommended for dissection), rate less than 5%.

RESULTS

Between 2014 and 2017, 1065 patients with EGJ tumor were screened, and 371 were enrolled. Among 358 patients who underwent surgical resection, category-1 nodes included abdominal stations 1, 2, 3, 7, 9, and 11p, whereas category-2 nodes included abdominal stations 8a, 19, and lower mediastinal station 110. If esophageal involvement exceeded 2.0 cm, station 110 was assigned to category-1. Among 98 patients who had either adenocarcinoma with esophageal involvement over 3.0 cm or squamous cell carcinoma, there were no category-1 nodes in the upper/middle mediastinal field, whereas category-2 nodes included upper mediastinal station 106recR and middle mediastinal station 108. When esophageal involvement exceeded 4.0 cm, station 106recR was assigned to category-1.

CONCLUSION

The study accurately identified the distribution of lymph node metastases from EGJ tumors and the optimal extent of subsequent lymph node dissection.

摘要

目的

本研究旨在通过一项前瞻性全国多中心研究，确定食管胃交界（EGJ）肿瘤 2 种组织学类型的最佳淋巴结清扫范围，基于转移发生率。

背景

由于大多数先前的研究都是回顾性的，EGJ 肿瘤的最佳手术方式尚未标准化。

方法

在术前，入组 cT2-T4 腺癌或位于 EGJ 近端 2.0cm 内的鳞癌患者。外科医生按照方案规定，使用经腹经膈肌或右经胸入路，对所有预设的淋巴结进行清扫。主要终点是每个淋巴结的转移率。根据转移率对淋巴结进行分类，如下：1 类（强烈推荐清扫），转移率大于 10%；2 类（弱推荐清扫），转移率为 5%至 10%；3 类（不推荐清扫），转移率小于 5%。

结果

2014 年至 2017 年，对 1065 例 EGJ 肿瘤患者进行了筛选，其中 371 例入组。在 358 例接受手术切除的患者中，1 类淋巴结包括腹部站 1、2、3、7、9 和 11p，而 2 类淋巴结包括腹部站 8a、19 和下纵隔站 110。如果食管受累超过 2.0cm，则将站 110 归为 1 类。在 98 例食管受累超过 3.0cm 的腺癌或鳞癌患者中，纵隔上野没有 1 类淋巴结，而 2 类淋巴结包括纵隔上野站 106recR 和中纵隔站 108。当食管受累超过 4.0cm 时，将站 106recR 归为 1 类。