Early esophageal cancer - Pattern of lymphatic spread and prognostic factors for long-term survival after surgical resection
Early esophageal cancer - Pattern of lymphatic spread and prognostic factors for long-term survival after surgical resection
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DOI：
10.1097/01.sla.0000184211.75970.85
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发表时间：
2005-10-01
影响因子：
9
通讯作者：
Siewert, JR
中科院分区：
文献类型：
--
作者：
Stein, HJ;Feith, M;Siewert, JR
目的：本研究的目的是评估早期鳞状细胞癌和腺癌患者淋巴管播散的患病率和模式，并确定切除和淋巴结清扫术后长期生存的预后因素。背景数据摘要：不进行淋巴结清扫的有限内镜方法越来越多地应用于早期食管癌患者。材料和方法：总共 290 名早期食管癌患者 癌症（157 例腺癌，133 例鳞状细胞癌）通过系统淋巴结切除术进行手术切除。评估样本的淋巴扩散的流行率和模式。通过多变量分析确定预后因素。结果：70 例局限于粘膜的腺癌患者中无一例出现淋巴扩散，而 26 例粘膜鳞状细胞癌患者中只有 2 例出现淋巴扩散。与粘膜下腺癌患者相比，粘膜下鳞状细胞癌患者的淋巴扩散更为常见（36.4% vs 20.7%）。尽管早期腺癌的淋巴结转移通常仅限于局部淋巴结站，但早期鳞状细胞癌中远处淋巴扩散很常见。在多变量分析中，只有组织学肿瘤类型和淋巴结转移的存在是长期生存的独立预测因素。早期腺癌的五年生存率为 83.4%，早期鳞状细胞癌为 62.9%；有/无淋巴扩散的患者五年生存率为 48.2%，而无淋巴扩散的患者则为 79.5%。 讨论：早期食管鳞状细胞癌和腺癌的淋巴扩散患病率和模式以及长期预后存在显着差异。有限切除技术和个体化淋巴结清扫策略似乎适用于早期腺癌患者。
Objective: The objective of this study was to assess the prevalence and pattern of lymphatic spread in patients with early squamous cell and adenocarcinoma and identify prognostic factors for long-term survival after resection and lymphadenectomy.Summary Background Data: Limited endoscopic approaches without lymphadenectomy are increasingly applied in patients with early esophageal cancer.Material and Methods: A total of 290 patients with early esophageal cancer (157 adenocarcinoma, 133 squamous cell cancer) had surgical resection with systematic lymphadenectomy. Specimens were assessed for prevalence and pattern of lymphatic spread. Prognostic factors were determined by multivariate analysis.Results: None of the 70 patients with adenocarcinoma limited to the mucosa had lymphatic spread, as compared with 2 of 26 with mucosal squamous cell cancer. Lymphatic spread was more common in patients with submucosal squamous cell cancer as compared with submucosal adenocarcinoma (36.4% versus 20.7%). Although lymph node metastases were usually limited to locoregional lymph node stations in early adenocarcinoma, distant lymphatic spread was frequent in early squamous cell cancer. On multivariate analysis, only histologic tumor type and the presence of lymph node metastases were independent predictors of long-term survival. Five-year survival rate was 83.4% for early adenocarcinoma versus 62.9% for early squamous cell cancer and 48.2% versus 79.5% for patients with/without lymphatic spread.Discussion: Prevalence and pattern of lymphatic spread as well as long-term prognosis differ markedly between early esophageal squamous cell and adenocarcinoma. Limited resection techniques and individualized lymphadenectomy strategies appear applicable in patients with early adenocarcinoma.