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中华胸部外科电子杂志 ›› 2024, Vol. 11 ›› Issue (04) : 211 -218. doi: 10.3877/cma.j.issn.2095-8773.2024.04.01

论著

胸段食管鳞状细胞癌中锁骨上淋巴结转移对预后的影响:一项大型回顾性研究
高鹏强1, 林军鹏1, 王佩元1, 林辉1, 周航1, 魏文巍1, 柳硕岩1, 王枫1,()   
  1. 1.350011 福州,福建医科大学福临床医学院,福建省肿瘤医院
  • 收稿日期:2024-06-03 修回日期:2024-07-07 接受日期:2024-08-08 出版日期:2024-11-28
  • 通信作者: 王枫
  • 基金资助:
    福建省科技创新联合基金项目(2023Y9424)

Impact of supraclavicular lymph node metastasis on the prognostic of thoracic oesophageal squamous cell carcinoma: a large retrospective study

Pengqiang Gao1, Junpeng Lin1, Peiyuan Wang1, Hui Lin1, Hang Zhou1, Wenwei Wei1, Shuoyan Liu1, Feng Wang1,()   

  1. 1.Clinical Oncology School of Fujian Medical University,Fujian Cancer Hospital,Fuzhou 350011,China*Co-first authors.
  • Received:2024-06-03 Revised:2024-07-07 Accepted:2024-08-08 Published:2024-11-28
  • Corresponding author: Feng Wang
引用本文:

高鹏强, 林军鹏, 王佩元, 林辉, 周航, 魏文巍, 柳硕岩, 王枫. 胸段食管鳞状细胞癌中锁骨上淋巴结转移对预后的影响:一项大型回顾性研究[J]. 中华胸部外科电子杂志, 2024, 11(04): 211-218.

Pengqiang Gao, Junpeng Lin, Peiyuan Wang, Hui Lin, Hang Zhou, Wenwei Wei, Shuoyan Liu, Feng Wang. Impact of supraclavicular lymph node metastasis on the prognostic of thoracic oesophageal squamous cell carcinoma: a large retrospective study[J]. Chinese Journal of Thoracic Surgery(Electronic Edition), 2024, 11(04): 211-218.

目的

探索胸段食管鳞状细胞癌(ESCC)患者锁骨上淋巴结(SCLN)转移对预后的影响。

方法

收集自1999—2009年在福建省肿瘤医院胸外科行食管切除术加三野淋巴结清扫术的胸段食管鳞癌患者的临床数据和生存资料。

结果

共纳入1 812例患者,其中739例(40.8%)无淋巴结转移,878例(48.5%)至少有1枚淋巴结转移但无SCLN转移,195例(10.8%)有包括SCLN转移的淋巴结转移。淋巴结阴性组的5年生存率为72.4%,无SCLN转移的淋巴结阳性组5年生存率为为43.6%,有SCLN转移组5年生存率为32.3%,3者生存情况比较,差异有统计学意义(P<0.001)。在多因素变量分析中,男性(P<0.001)、更高的T分期(P=0.005)和更高的N分期(P<0.001)是影响总生存率的独立危险因素,而SCLN转移则没有统计学意义(P=0.521)。将SCLN转移患者的5年生存数据做亚组比较显示,SCLN转移组的预后与N2组(P=0.281)相当,显著优于N3组患者(P=0.034)。

结论

SCLN可作为食管鳞癌区域淋巴结清扫的一部分,并且在分期中SCLN转移可作为N2期,以提高分期的准确性改善患者预后。

Objective

To investigate the prognostic impact of metastasis to supraclavicular lymph nodes(SCLNs) in patients with thoracic esophageal squamous cell carcinoma(ESCC).

Methods

The clinical and survival information of the patients from 1999 to 2009 with thoracic ESCC who underwent esophagectomy with 3-field lymphadenectomy at the Department of Thoracic Surgery,Fujian Cancer Hospital were collected and analyzed.

Results

Of the 1 812 patients,739(40.8%) had no lymph node metastases,878(48.5%) had at least 1 positive node but were SCLN-negative,and 195(10.8%) had SCLN metastases.The 5-year survival rate was 72.4% for nodenegative patients,43.6% for node-positive patients without SCLN metastases,and 32.3% for patients with SCLN metastases.The difference was significant(P<0.001).In the multivariate analysis,the male sex(P<0.001),a higher T stage(P=0.005),and a higher N stage(P<0.001) retained statistical significance as adverse prognostic factors for overall survival,while SCLN metastasis did not(P=0.521).A comparison of the 5-year survival rates among patients with SCLN metastases revealed that the SCLN-positive group was more similar to the N2 group(P=0.281) than to the N3 group(P=0.034).

Conclusions

SCLN can be used as part of regional lymph node dissection for squamous oesophageal cancer and SCLN metastases can be used as stage N2 in staging to improve the accuracy of staging to improve patient prognosis.

表1 一般临床病理资料
图1 基于锁骨上淋巴结状态食管鳞癌患者术后生存曲线
图2 基于N分期的食管鳞癌患者术后生存曲线
图3 基于N分期和锁骨上淋巴结状态食管鳞癌患者术后生存曲线亚组分析
表2 影响食管鳞癌总体生存的单因素分析
图4 基于病灶位置和锁骨上淋巴结状态食管鳞癌患者术后生存曲线亚组分析。A:胸上段;B:胸中段;C:胸下段
表3 影响食管鳞癌总体生存的多因素分析
图5 基于N分期与锁骨上淋巴结状态食管鳞癌患者术后生存曲线
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