ESOPHAGEAL SQUAMOUS-CELL CARCINOMA - PATHOLOGY AND PROGNOSIS
ESOPHAGEAL SQUAMOUS-CELL CARCINOMA - PATHOLOGY AND PROGNOSIS
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DOI：
10.1007/bf00316810
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发表时间：
1994-05-01
影响因子：
2.6
通讯作者：
HANYU, F
中科院分区：
文献类型：
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作者：
IDE, H;NAKAMURA, T;HANYU, F
1985年至1992年，共403例胸段食管鳞状细胞癌切除患者进行了组织病理学评价，并检查了与生存相关的各种病理结果。关于肿瘤浸润深度，8例（2%）为pTis，110例（27%）为pT 1，48例（12%）为pT 2，202例（50%）为pT 3，35例（9%）为pT 4。淋巴结侵犯299例（74%），血管侵犯200例（49%），壁内转移45例（11%），淋巴结转移232例（58%）。在pT 1癌病例中，4%的粘膜癌和30%的粘膜下癌有淋巴结转移。浸润较深的肿瘤有较高的淋巴结转移率：74%的pT 3癌和83%的pT 4癌。淋巴结转移部位分为纵隔、颈部和腹部，淋巴结转移率分别为49%、14%和41%。全组手术死亡率为3.2%，5年生存率为44.8%。根治性切除（R（0）和R（1））的5年生存率为49.5%，姑息性切除（R（2））的5年生存率不超过3年。相对于肿瘤位置，生存率无显著差异。多因素分析显示，影响根治性切除病例预后的主要因素为pT分级、血管侵犯、淋巴结转移和壁内转移。淋巴结阳性病例的预后不依赖于阳性淋巴结部位。只有一个阳性淋巴结的患者预后较好，而六个或更多阳性淋巴结的患者预后较差。关于淋巴结转移，其他恶化预后的因素是大于1 cm的阳性淋巴结，2 - 3个野转移，以及下1/3食管癌病例中的阳性颈淋巴结。
Between 1985 and 1992 a total of 403 patients with resected thoracic esophageal squamous cell carcinoma were evaluated histopathologically, and various pathologic findings related to survival were examined. Concerning depth of tumor invasion, 8 (2%) cases were pTis, 110 (27%) were pT1, 48 (12%) were pT2, 202 (50%) were pT3, and 35 (9%) were pT4. Lymphatic invasion was detected in 299 cases (74%), blood vessel invasion in 200 cases (49%), intramural metastasis in 45 (11%), and lymph node metastasis in 232 (58%). In pT1 carcinoma cases, 4% of mucosal carcinomas and 30% of submucosal carcinomas had lymph node metastasis. Tumors with deeper invasion had a higher incidence of lymph node metastasis: 74% of pT3 carcinomas and 83% of pT4 carcinomas. The sites of lymph node metastasis were divided into mediastinal, cervical, and abdominal fields; and rates of lymph node metastasis were 49%, 14%, and 41%, respectively. In all resected cases, the operative mortality rate was 3.2%, and the overall 5-year survival rate was 44.8%. The 5 year survival rate of patients with curative resection (R(0) and R(1)) was 49.5%, whereas patients with palliative resection (R(2)) did not survive more than 3 gears. There was no significant difference in survival relative to tumor location. In curatively resected cases, the significant prognostic factors by multivariate analysis were pT category, vascular invasion, lymph node metastasis, and intramural metastasis. Prognosis of lymph node-positive cases did not depend on the positive node site. Patients with only one positive node had a better prognosis, and those with six or more positive nodes had a poor prognosis. Concerning lymph node metastasis, other factors that worsened prognosis were a positive node larger than 1 cm, two- to three field metastasis, and positive cervical nodes in cases of lower-third esophageal carcinoma.