Nishimaki T, Suzuki T, Tanaka Y, Aizawa K, Hatakeyama K, Muto T
First Department of Surgery, Niigata University School of Medicine, Japan.
World J Surg. 1996 Jan;20(1):32-7. doi: 10.1007/s002689900006.
The patterns of tumor spread and long-term survival of patients with (n = 54) and without (n = 270) intramural metastasis from esophageal cancer were investigated after either extended radical (n = 155) or less radical (n = 169) esophagectomy. The purpose was to evaluate whether extended radical esophagectomy has an impact on the long-term survival of patients with intramural metastases from the disease. The patients with intramural metastasis had significantly larger primary tumors (p < 0.01) and more frequent T4 tumors (p < 0.001), stage IV disease (p < 0.05), lymphatic invasion (p < 0.05), and lymph node metastasis (p < 0.01) than did those without intramural metastasis. The survival rates of patients with intramural metastases were significantly worse than those of patients without intramural metastases after resection (p < 0.001). No patient with intramural metastases survived more than 4 years after either extended or less radical esophagectomy, and there was no significant difference between the two survival curves. Therefore intramural metastases should be considered local indicators of advanced esophageal cancer, and radical esophagectomy may not be indicated for patients with intramural metastasis from the disease.
在接受扩大根治性（n = 155）或非扩大根治性（n = 169）食管切除术后，对54例有壁内转移和270例无壁内转移的食管癌患者的肿瘤扩散模式和长期生存率进行了研究。目的是评估扩大根治性食管切除术是否对患有该病壁内转移的患者的长期生存有影响。与无壁内转移的患者相比，有壁内转移的患者原发肿瘤明显更大（p < 0.01），T4期肿瘤更常见（p < 0.001），IV期疾病（p < 0.05）、淋巴浸润（p < 0.05）和淋巴结转移（p < 0.01）更频繁。切除术后，有壁内转移的患者的生存率明显低于无壁内转移的患者（p < 0.001）。无论是扩大根治性还是非扩大根治性食管切除术后，没有壁内转移的患者存活超过4年，两条生存曲线之间没有显著差异。因此，壁内转移应被视为晚期食管癌的局部指标，对于患有该病壁内转移的患者可能不建议进行根治性食管切除术。
