转移淋巴结的数量和范围对食管癌预后的影响
冯键;茅腾;陈文虎;方文涛
【期刊名称】《中华胃肠外科杂志》 【年(卷),期】2011(014)009
【摘要】Objective To evaluate the influence of the number, station and field of metastatic lymph node on the prognosis of thoracic esophageal cancer and to investigate an ideal nodal staging method. Methods Clinicopathological and follow-up data of the 204 patients who underwent thoracic esophagectomy from June 2001 to December 2009 were analyzed retrospectively and all the patients were re-staged according to the 7th edition of the AJCC TNM staging system. Log-rank test was applied to perform survival analysis according to lymph node metastasis staging (number, station, and field),Cox proportional hazard model was used to screen risk factors. Results The follow-up rate was 93.1％ (190/204). The median follow up time was 37.0(0-104) months. The overall and cancer-specific 5-year survival rates were 35.0％ and 38.8％. When grouped according to the number of metastatic lymph node (0, 1-2,3-6, ≥ 7), the 5-year survival rates of pNO, pN 1, pN2 and pN3 were 47.8, 31.8％, 11.5％ and 0 respectively (P=0.000). When grouped according to the number of stations of metastatic lymph node [ N (0s), N ( 1 s) ( 1 station LN metastasis), N ( ≥ 2s) ( ≥ 2 stations LN metastasis)], the 5-year survival rates of N (0s), N (1s), N (≥2s) were
47.8％, 31.5％ and 11.3％ respectively (P=0.000). When grouped according to the number of fields of metastatic lymph node, the 5-year survival rates of NO, 1field, 2 fields and 3 fields involvement were 47.8％, 34.2％, 12.1％ and 0 respectively(P=0.000). Cox regression showed that the number of stations [P=0.043, RR(95％ CI)=1.540(1.013-2.342)], and the number of fields[P=0.010, RR(95％ CI)=2.187(1.210-3.951)]of metastatic lymph node were the independent risk factors for survival. Conclusions The extent of metastatic lymph node is an independent risk factor for the prognosis of esophageal cancer patients. Revision of the current N-classification of TNM staging system according to the number of stations of metastatic lymph node may be more reasonable.%目的探讨转移淋巴结枚数、组数及野数对食管癌患者预后的影响，为更加合理的淋巴结转移分级提供参考。方法回顾性分析2001年6月至2009年12月间在上海市胸科医院进行手术治疗的204例食管癌患者的临床资料，并按照2009年第七版国际食管癌TNM分期对所有患者进行重新分期。采用Log-rank检验和Cox比例风险模型来评估转移淋巴结枚数、组数及野数对患者预后的影响。结果204例患者随访率为93.1％(190/204),中位随访时间为37(0～104)个月,5年总体生存率为35.0％,5年病因生存率38.8％。按转移淋巴结枚数，pNo(无淋巴结转移，86例)、pN1（1～2枚转移淋巴结，80例）、pN2（3～6枚转移淋巴结,35例）和pN3(7枚以上转移淋巴结,3例)患者5年生存率分别为47.8％、31.8％、11.5％和0,差异有统计学意义（P=0.000）；按转移淋巴结组数，无淋巴结转移（86例）、1组淋巴结转移（56例）和2组
以上淋巴结转移（62例）患者5年生存率分别为47.8％、31.5％和11.3％,差异有统计学意义(P=0.000)；按转移淋巴结野数，无淋巴结转移（86例）、1野转移（70例）、2野转移(43例)和3野转移（5例）患者5年生存率分别为47.8％、34.2％、12.1％和0,差异有统计学意义(P=0.000)。经Cox模型证实，转移淋巴结的组数[P=0.043,RR (95％ CI) =1.540(1.013～2.342)]和转移淋巴结野数[P=0.010,RR (95％ CI)=2.187(1.210～3.951)]均是影响患者预后的独立因素。结论转移淋巴结的范围是影响食管癌预后的重要因素;以转移淋巴结组数进行淋巴结分级，可以统一标准，更加合理、准确地预测食管癌手术患者的预后。
【总页数】4页(715-718)
【关键词】食管肿瘤;TNM分期；淋巴结转移；生存分析 【作者】冯键;茅腾;陈文虎;方文涛
【作者单位】200030 上海市胸科医院胸外科;200030 上海市胸科医院胸外科;200030 上海市胸科医院胸外科;200030 上海市胸科医院胸外科 【正文语种】中文 【中图分类】 【文献来源】
https://www.zhangqiaokeyan.com/academic-journal-cn_chinese-journal-gastrointestinal-surgery_thesis/0201234337939.html 【相关文献】
1.胸段食管癌淋巴结转移数量对预后的影响分析 [J], 王春利; 张双平; 韩小友; 曹国珍; 王晓军; 游志恒; 郭粽亮
转移淋巴结的数量和范围对食管癌预后的影响
