胸段食管鳞癌淋巴结转移规律及其对放疗临床靶区的意义

目的 研究胸段食管鳞癌淋巴结转移的规律,探讨临床病理因素对淋巴结转移的影响,为胸段食管癌放射治疗临床靶区的制定提供依据.方法 回顾性分析1077例行根治术的胸段食管鳞癌患者的淋巴结转移规律,单因素及多因素Logistic回归分析评估临床病理因素对淋巴结转移的影响.结果 胸上段食管癌颈部、上纵隔、中纵隔、下纵隔及腹部淋巴结转移率分别为16.7%、33.3%、11.1%、5.6%和5.6%,胸中段食管癌分别为4.0%、3.8%、28.5%、7.1%和17.1%,胸下段食管癌分别为1.5%、3.0%、22.7%、37.0%和33.2%.多因素Logistic回归分析结果显示,肿瘤长度、浸润深度和分化程度是影响胸段食管癌淋巴结转移的独立危险因素(OR分别为1.145、1.501和1.973).结论 影响胸段食管鳞癌淋巴结转移的主要因素有肿瘤浸润深度、分化程度及肿瘤长度,应综合考虑肿瘤部位及这些因素,以选择合适的放疗临床靶区.

Impact of the pattern of lymph node metastasis on the clinical target volume in radiotherapy for thoracic esophageal squamous cell carcinoma

Objective To study the pattern of lymph node metastasis of thoracic esophageal squamons cell carcinoma(ESCC)after esophagectomy and its impact on the clinical target volume(CTV) delineation in radiotherapy fpr thoracic ESCC.Methods The pattern of lymph node metsstasis was retrospectively analyzed in 1077 patients with primary thoracic ESCC.All patients recieved esophagectomy with two-or three-field lymphadenectomy.The clinicopathologic factors related to lymph node metastasiswere then analyzed using logistic regression analysis.Results The rates of cervical,upper mediastinal,middle mediastinal,lower mediastinal and abdominal cavity lymph node metastasis were 16.7%,33.3%.11.1%,5.6% and 5.6%.respectively.The rates of those node metastasis in the middle thoracic ESCC were 4.0%,3.8%,28.5%,7.1% and 17.1%,respectively,and the rates of those node metastasis in the lower thoracic ESCC were 1.5%,3.0%,22.7%,37.0% and 33.2%,respectively.The depth of tunlor invasion,histologic differentiation and the length of tumor were showed to be statistically most significant risk factors of lymph node metastasis of ESCC(P<0.001).Conclusion The depth of tumor invasion,histologic differentiation,and length of tumor were closely correlated with lymph node metastasis of ESCC.AIl these factors and tumor location should be considered comprehensively when designing the target volumefor radiotherapy.