Yuan L G, Mao Y S
Department of Thoracic Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100021, China.
Zhonghua Zhong Liu Za Zhi. 2023 Jun 23;45(6):508-513. doi: 10.3760/cma.j.cn112152-20210820-00631.
To understand the characteristics and influencing factors of lymph node metastasis of the right recurrent laryngeal nerve in thoracic esophageal squamous cell carcinoma (ESCC), and to explore the reasonable range of lymph node dissection and the value of right recurrent laryngeal nerve lymph node dissection. The clinicopathological data with thoracic ESCC were retrospectively analyzed, and the characteristics of lymph node metastasis along the right recurrent laryngeal nerve and its influencing factors were explored. Eighty out of 516 patients had lymph node metastasis along the right recurrent laryngeal nerve, the metastasis rate was 15.5%. Among 80 patients with lymph node metastasis along the right recurrent laryngeal nerve, 25 cases had isolated metastasis to the right recurrent laryngeal nerve lymph node but no other lymph nodes. The incidence of isolated metastasis to the recurrent laryngeal nerve lymph node was 4.8% (25/516). A total of 1 127 lymph nodes along the right recurrent laryngeal nerve were dissected, 115 lymph nodes had metastasis, and the degree of lymph node metastasis was 10.2%. T stage, degree of tumor differentiation and tumor location were associated with right paraglottic nerve lymph node metastasis (all <0.05). The lymph node metastasis rate along the right recurrent laryngeal in patients with upper thoracic squamous cell carcinoma (23.4%, 26/111) was higher than that of patients with middle (13.5%, 40/296) and lower (12.8%, 14/109) thoracic squamous cell carcinoma (=0.033). In patients with poorly differentiated ESCC (20.6%, 37/180) the metastasis rate was higher than that of patients with moderately (14.6%, 39/267) and well-differentiated (5.8%, 4/69; <0.05). The lymph node metastasis rate of patients with stage T4 (27.3%, 3/11) was higher than that of patients with stage T1 (9.6%, 19/198), T2 (19.0%, 16/84) and T3 (18.8%, 42/1 223; <0.05). Multivariate regression analysis showed that tumor location (=0.61, 95% 0.41-0.90, =0.013), invasion depth (=1.46, 95% 1.11-1.92, =0.007), and differentiation degree (=1.67, 95% 1.13-2.49, =0.011) were independent risk factors for lymph node metastasis along right recurrent laryngeal nerve of ESCC. The lymph node along the right recurrent laryngeal nerve has a higher rate of metastasis and should be routinely dissected in patients with ESCC. Tumor location, tumor invasion depth, and differentiation degree are risk factors for lymph node metastasis along right recurrent laryngeal nerve in patients with ESCC.
了解胸段食管鳞状细胞癌(ESCC)右侧喉返神经淋巴结转移的特点及影响因素,探讨合理的淋巴结清扫范围及右侧喉返神经淋巴结清扫的价值。回顾性分析胸段ESCC的临床病理资料,探讨右侧喉返神经旁淋巴结转移特点及其影响因素。516例患者中80例出现右侧喉返神经旁淋巴结转移,转移率为15.5%。80例右侧喉返神经旁淋巴结转移患者中,25例为单纯右侧喉返神经淋巴结转移,无其他淋巴结转移。喉返神经淋巴结单纯转移发生率为4.8%(25/516)。共清扫右侧喉返神经旁淋巴结1127枚,其中115枚有转移,淋巴结转移度为10.2%。T分期、肿瘤分化程度及肿瘤部位与右侧声门旁神经淋巴结转移有关(均<0.05)。胸段上段食管鳞状细胞癌患者右侧喉返神经旁淋巴结转移率(23.4%,26/111)高于胸段中段(13.5%,40/296)和下段(12.8%,14/109)食管鳞状细胞癌患者(P=0.033)。低分化ESCC患者转移率(20.6%,37/180)高于中分化(14.6%,39/267)和高分化(5.8%,4/69;P<0.05)患者。T4期患者淋巴结转移率(27.3%,3/11)高于T1期(9.6%,19/198)、T2期(19.0%,16/84)和T3期(18.8%,42/1223;P<0.05)患者。多因素回归分析显示,肿瘤部位(P=0.61,95%CI 0.41-0.90,P=0.013)、浸润深度(P=1.46,95%CI 1.11-1.92,P=0.007)和分化程度(P=1.67,95%CI 1.13-2.49,P=0.011)是ESCC右侧喉返神经旁淋巴结转移的独立危险因素。右侧喉返神经旁淋巴结转移率较高,ESCC患者应常规清扫。肿瘤部位、肿瘤浸润深度和分化程度是ESCC患者右侧喉返神经旁淋巴结转移的危险因素。