Pattern of recurrence after extended esophagectomy for squamous cell carcinoma of the esophagus.
Pattern of recurrence after extended esophagectomy for squamous cell carcinoma of the esophagus.
复制标题
食管鳞状细胞癌扩大食管切除术后的复发模式。
作者：
I. Kyriazanos;M. Tachibana;M. Shibakita;H. Yoshimura;S. Kinugasa;D. Dhar;T. Nakamoto;T. Fujii;N. Nagasue
背景/目标
进一步探讨食管鳞癌全身扩散的可能机制。
方法论
在151例接受根治性食道切除的患者中，41例(27.1%)发展为食道癌复发。远处血源性复发9例(22%)，非血源性复发17例(41.5%)，混合型复发15例(36.5%)。58.5%的复发者伴有血源性沉积。分析几种临床病理因素与复发类型的关系。
结果
单因素分析发现，缺乏辅助化疗、肿瘤位于食道下段和肿瘤去分化是血源性复发的促进因素。低分化或未分化肿瘤的微血管密度显著高于中分化或高分化肿瘤。肿瘤分化程度和肿瘤较低部位是血源性复发的独立预测因素。
结论
低分化或未分化肿瘤位于食道下部，微血管密度高，应考虑扩大食道切除术后血行复发的高风险。
BACKGROUND/AIMS
To further investigate the underlying mechanism of the systemic spread of esophageal squamous cell carcinoma.
METHODOLOGY
Out of 151 patients who underwent a curative esophageal resection, 41 (27.1%) developed recurrent esophageal cancer. Nine recurrences (22%) were distant-hematogenous, 17 (41.5%) non-hematogenous, and 15 (36.5%) mixed. Hematogenous deposits accompanied 58.5% of the recurrences. The relation between several clinicopathological factors and the pattern of recurrence was evaluated.
RESULTS
Univariate analysis recognized the lack of adjuvant chemoradiation, the tumor location in the lower esophagus and the tumor dedifferentiation as promoting factors for hematogenous recurrence. Poorly differentiated or undifferentiated tumors presented a significantly higher microvessel density than moderately or well differentiated tumors. Tumor differentiation and tumor lower localization were independent predictors of hematogenous recurrence.
CONCLUSIONS
Patients with poorly differentiated or undifferentiated tumors, which are located at the lower esophagus and present high microvessel density, should be considered at high risk for hematogenous recurrences after extended esophagectomy.