Siewert Ⅱ型和Ⅲ型食管胃结合部腺癌的淋巴结转移规律

Pattern of lymphatic metastasis of Siewert type Ⅱ and Ⅲ adenocarcinoma of the esophagogastric junction

    摘要
  • 摘要: 目的：探讨Siewert Ⅱ、Ⅲ型食管胃结合部腺癌(AEG)的淋巴结转移规律。
    方法：回顾性分析2003年1月至2007年12月大连医科大学附属第一医院收治的152例Siewert Ⅱ、Ⅲ型AEG患者的临床资料，比较两者的临床病理特征、手术治疗相关资料及淋巴结转移规律。自患者首次入院开始随访，出院后采用电话随访。随访时间截至2012年12月或死亡时间。无序资料分析采用χ2检验，有序资料分析采用秩和检验，应用Kaplan Meier法绘制生存曲线，组间生存率比较采用Log-rank检验。
    结果：152例AEG患者中，行R0切除138例，R1、R2切除14例。总体R0切除率为90.79%(138/152)。Siewert Ⅱ、Ⅲ型AEG患者R0切除率分别为92.6%(63/68)和89.3%(75/84)。Siewert Ⅱ型AEG以第1、2、3、7、8a和110组淋巴结转移为主，其转移率分别为63.6%、56.4%、54.5%、47.3%、23.6%和23.6%；其次为第11、111和 9组 淋巴结转移，其转移率分别为16.4%、16.4%和12.7%。Siewert Ⅲ型AEG以第1、2、3、7、8a、4sb、11、4sa、4d组淋巴结转移为主，其转移率分别为60.6%、57.7%、50.7%、46.5%、28.2%、26.8%、23.9%、19.7%、11.3%；其次为第9、10、5、6组淋巴结转移，其转移率分别为19.7%、16.9%、14.1%和12.7%。Siewert Ⅱ型AEG患者第4sa、4sb、4d、5、6、10、11组淋巴结转移率低于Siewert Ⅲ型AEG患者，而第110、111组淋巴结转移率高于Siewert Ⅲ型AEG患者，两者比较，差异有统计学意义(χ2=13.043，P<0.05)。
    结论：Siewert Ⅱ型AEG以第1、2、3、7、8a、110组淋巴结转移为主，其次为第11、111、9组淋巴结转移。Siewert Ⅲ型AEG以第1、2、3、7、8a、4sb、11、4sa、4d组淋巴结转移为主，其次为第9、10、5、6组淋巴结转移。

     

    Abstract: Objective:To investigate the pattern of lymphatic metastasis of Siewert type Ⅱ and Ⅲ adenocarcinoma of the esophagogastric junction (AEG).
    Methods:The clinical data of 152 patients with Siewert type Ⅱ and Ⅲ AEG who were admitted to the First Affiliated Hospital of Dalian Medical University from January 2003 to December 2007 were retrospectively analyzed. The follow up began at the first admission, and ended at December 2012 or the death of patients. Patients were followed up via phone call. The unordered data were analyzed using the chi square test, and the ordered data were analyzed using the analysis of variance. The survival curve drawn using the Kaplan Meier method, and the comparison of survival rates was done by Log-rank test.
    Results:Of the 152 patients, 138 received resection, 14 received R1 or R2 resection. The overall resection rate was 90.79%(138/152). The resection rates of patients with Siewert type Ⅱ, Ⅲ AEG were 92.6%(63/68) and 89.3%(75/84). For Siewert type Ⅱ AEG, the incidences of lymphatic metastasis were high in No.1 (63.6%), No.2 (56.4%), No.3 (54.5%), No.7 (47.3%), No.8a (23.6%) and No.110 (23.6%) lymph nodes, and then followed by No.11 (16.4%), No.111 (16.4%) and No.9 (12.7%) lymph nodes. For Siewert  type Ⅲ AEG, the incidences of lymphatic metastasis were high in No.1 (60.6%), No.2 (57.7%), No.3 (50.7%), No.7 (46.5%), No.8a (28.2%), No.4sb(26.8%), No.11 (23.9%), No.4sa (19.7%), No.4d (11.3%) lymph nodes, and then followed by No.9 (19.7%), No.10 (16.9%), No.5 (14.1%) and No.6 (12.7%) lymph nodes. The metastatic rates of No.4sa, 4sb, 4d, 5, 6, 10 and 11 lymph nodes of Siewert type Ⅱ AEG were significantly lower than those of Siewert type Ⅲ AEG, while the metastatic rates of No.110 and 111 lymph nodes of Siewert type Ⅱ AEG were significantly higher than those of Siewert type Ⅲ AEG (χ2=13.043, P<0.05).
    Conclusion:For Siewert type Ⅱ AEG, lymph node metastasis is mostly seen in No.1, 2, 3, 7, 8a, 110 lymph nodes, and followed by No. 11, 111 and 9 lymph nodes; for Siewert type Ⅲ AEG, lymph node metastasis is mostly seen in No. 1, 2, 3, 7, 8a, 4sb, 11, 4sa, 4d lymph nodes, and then followed by No. 9, 10, 5, 6 lymph nodes.

     

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