Liu C C, Fahn H J, Li W Y, Wu Y C, Huang M H, Wang L S
Department of Surgery, Veterans General Hospital-Taipei, Taiwan, ROC.
Zhonghua Yi Xue Za Zhi (Taipei). 1998 Feb;61(2):77-84.
In esophageal carcinoma lymph node metastasis is one of the most important factors of prognosis. This prospective study evaluated the incidence and extent of lymph node metastasis, and assessed the relationship between the depth of tumor invasion and lymph node metastasis in esophageal carcinoma.
Between 1985 and 1996, tissue samples from 112 patients undergoing radical esophagectomy and gastric substitution for squamous cell carcinoma of the intrathoracic esophagus were collected. Patients with distant organ metastasis were excluded. All specimens were evaluated and sent for histopathologic examination.
In 108 men and four women with a mean age of 63.1 years, the average number of dissected lymph nodes in one surgical procedure, was 30 per person. The most commonly involved nodes were the periesophageal (42.9%) and the perigastric (42.9%) nodes, followed by the recurrent laryngeal nerve (23.8%) and thoracic paratracheal (22.2%) nodes. For tumors in the upper third of the esophagus, the most frequently involved nodal groups were the periesophageal (28.6%) and the paratracheal (28.6%) nodes, followed by the recurrent laryngeal nerve (21.4%) the deep cervical (21.4%), and the perigastric (21.4%) nodes. For tumors in the middle third of the esophagus, the periesophageal nodes (27.3%) were most commonly involved, followed by the perigastric (18.2%) and the subcarina (10.6%) nodes. For tumors in the lower third of the esophagus, the perigastric lymph nodes (37.5%) were the most common nodal metastatic site, followed by the celiac (18.8%) and the recurrent laryngeal nerve (18.2%) nodes. Depth of tumor invasion was also found to correlate significantly with lymph node metastasis (p = 0.0015).
Wide lymph node metastasis between the neck and the upper abdomen occurs frequently in squamous cell carcinoma of the esophagus. For potentially curable esophageal carcinomas, en-bloc esophagectomy with complete locoregional lymph node dissection may provide favorable local control of the lesion and more accurate tumor staging.
在食管癌中，淋巴结转移是影响预后的最重要因素之一。本前瞻性研究评估了食管癌淋巴结转移的发生率和范围，并评估了肿瘤浸润深度与淋巴结转移之间的关系。
1985年至1996年间，收集了112例行根治性食管切除术并胃代食管治疗胸段食管鳞状细胞癌患者的组织样本。排除远处器官转移患者。对所有标本进行评估并送病理组织学检查。
108例男性和4例女性，平均年龄63.1岁，一次手术中平均每例清扫淋巴结30枚。最常受累的淋巴结是食管周围淋巴结（42.9%）和胃周围淋巴结（42.9%），其次是喉返神经旁淋巴结（23.8%）和胸段气管旁淋巴结（22.2%）。对于食管上段肿瘤，最常受累的淋巴结组是食管周围淋巴结（28.6%）和气管旁淋巴结（28.6%），其次是喉返神经旁淋巴结（21.4%）、颈深淋巴结（21.4%）和胃周围淋巴结（21.4%）。对于食管中段肿瘤，最常受累的是食管周围淋巴结（27.3%），其次是胃周围淋巴结（出18.2%）和隆突下淋巴结（10.6%）。对于食管下段肿瘤，胃周围淋巴结（37.5%）是最常见的淋巴结转移部位，其次是腹腔淋巴结（18.8%）和喉返神经旁淋巴结（18.2%）。还发现肿瘤浸润深度与淋巴结转移显著相关（p = 0.0015）。
食管癌鳞状细胞癌颈部和上腹部之间广泛的淋巴结转移很常见。对于潜在可治愈的食管癌，行整块食管切除术并完整清扫区域淋巴结可能对病变提供良好的局部控制并更准确地进行肿瘤分期。
