Nishimaki T, Tanaka O, Suzuki T, Aizawa K, Hatakeyama K, Muto T
First Department of Surgery, Niigata University School of Medicine, Japan.
Cancer. 1994 Jul 1;74(1):4-11. doi: 10.1002/1097-0142(19940701)74:1<4::aid-cncr2820740103>3.0.co;2-r.
The cervical nodes have been excluded from the category of regional nodes in cases of thoracic esophageal cancer in the present TNM classifications.
One hundred and forty-one patients with thoracic esophageal cancer who had undergone extensive radical lymphadenectomy were included in the study. The patterns of early lymph node metastasis from the disease, in terms of lymph node metastases from the intramural tumors or those found in patients with a single metastatic node, were studied. Prognostic significance of the removal of the positive nodes also was examined in relation to the metastatic sites.
Of the 47 patients with intramural cancer, only 21% had nodal metastases confined to the mediastinum, 11% had positive cervical nodes, and 23% had jumping metastases to the extramediastinal nodes. Of the 31 patients with a single metastatic node, 61% showed metastasis in a jumping fashion, and 19% had a positive node in the neck. Seventy-four (79.6%) of the 93 patients with vessel invasion also had lymph node metastases, whereas 20 (41.7%) of the 48 patients without vessel invasion had metastases to the lymph nodes (P < 0.001). The 5-year projected survival rate for patients with positive cervical nodes was 27%, with no significant difference in survival rate compared with that for patients with metastatic nodes in the mediastinum or the abdomen. The number of involved nodes was related significantly to outcome: The 5-year survival rates for the 45 patients with negative nodes the 66 patients with one to four positive nodes were 71.8 and 34.2%, respectively (P < 0.01), whereas none of the 27 patients with five or more positive nodes survived more than 3 years after the operation (P < 0.001).
The cervical nodes should be included in the category of regional nodes in cases of thoracic esophageal cancer on the basis of the patterns of early lymph node metastases and the prognostic significance of a lymphadenectomy for metastases to these nodes.
在当前的TNM分类中，胸段食管癌病例的颈部淋巴结已被排除在区域淋巴结类别之外。
本研究纳入了141例行广泛根治性淋巴结清扫术的胸段食管癌患者。研究了该疾病早期淋巴结转移的模式，包括壁内肿瘤的淋巴结转移情况或单个转移淋巴结患者的淋巴结转移情况。还根据转移部位检查了切除阳性淋巴结的预后意义。
在47例壁内癌患者中，仅21%的患者淋巴结转移局限于纵隔，11%的患者颈部淋巴结阳性，23%的患者出现跳跃性转移至纵隔外淋巴结。在31例单个转移淋巴结的患者中，61%表现为跳跃性转移，19%的患者颈部有阳性淋巴结。93例有血管侵犯的患者中有74例（79.6%）也有淋巴结转移，而48例无血管侵犯的患者中有20例（41.7%）有淋巴结转移（P<0.001）。颈部淋巴结阳性患者的5年预计生存率为27%，与纵隔或腹部有转移淋巴结的患者相比，生存率无显著差异。受累淋巴结数量与预后显著相关：45例淋巴结阴性患者的5年生存率为71.8%，66例有1至4个阳性淋巴结的患者为34.2%（P<0.01），而27例有5个或更多阳性淋巴结的患者术后无一人存活超过3年（P<0.001）。
基于早期淋巴结转移模式以及对这些淋巴结转移进行淋巴结清扫的预后意义，胸段食管癌病例的颈部淋巴结应纳入区域淋巴结类别。
