Metastatic characteristics of lymph node in cervical region and radiotherapy target volume after dissection of thoracic esophageal carcinoma
LI Cheng-lin*,WANG Ya-di, HAN Chun,LIU Qing, SUN Guo-gui, CHENG Yun-jie, JING Shao-wu, YANG Cong-rong
*Department of Radiotherapy, Fourth Hospital of Hebei Medical University, Shijiazhuang 050011, China Corresponding author:WANG Ya-di, Department of Radiotherapy, Military General Hospital of Beijing, Beijing 100700, China;Email:wangyadi@hotmail.com
Abstract：Objective To investigate the metastatic characteristics of cervical lymph node in thoracic esophageal cancer of two-field lymph node dissection after radical surgery and to provide evidence for postoperative radiotherapy. Methods Local-regional lymph node metastasis after surgery of 126 cases with esophageal squamous cell carcinoma from 2004 to 2009 were reviewed. Boundaries of cervical lymph node were according to Som,s imaging-based nodal classification system. Enumeration data were compared by χ2test, and the risk factors of lymph node metastasis were analyzed with Logistic regressive model. Results Lymph node metastasis rate of cervical region was up to 68.3% in all the cases with local-regional lymph node metastasis (86/126), and lymph node metastasis rate in levelⅠwas higher than those in the other levels (43.7%, 55/126). There was obvious difference in lymph node metastasis rate between the right and the left cervical region (53.2% vs 30.2%,χ2=13.73,P=0.000). Moreover, the results also shown that lymph node metastasis rate was notably increased in levelⅠ, Ⅱ and Ⅲa of the right compared with those of the left, showing statistical significance (43.7%∶15.1%,17.5%∶7.1%,17.5%∶5.6%,χ2=24.79,6.22,8.77,P=0.000,0.013,0.003).The sum of lymph node metastasis rate was 95%(82/86) in para-recurrent nerve and medial jugular vein, and 85%(73/86) in para-recurrent nerve. In addition, multivariate analysis showed that lymph node metastasis in levelⅠwas high risk factor for lymph node metastasis of levelⅡ. Conclusions Lymph node metastasis of cervical region mainly focused on para-recurrent nerve and medial jugular vein.
. Metastatic characteristics of lymph node in cervical region and radiotherapy target volume after dissection of thoracic esophageal carcinoma[J]. Chinese Journal of Radiation Oncology, 2012, 21(2): 126-128.
[1] 薛恒川,吴昌荣,张振斌,等.胸段食管癌胸腹二区淋巴结清扫及转移规律.癌症,2007,26:1020-1024. [2] 安丰山,黄金球,陈少湖.217例胸段食管癌淋巴结转移及其对预后影响的分析.癌症,2003,22:974-977. [3] 柳硕岩,佘志廉,朱坤寿.472例胸段食管癌行颈、胸、腹三野淋巴结清扫术的临床研究.福建医药杂志,2005,6:38-40. [4] 陈俊强,潘建基,陈明强,等.胸段食管癌淋巴结转移规律与放疗意义探讨.中华放射肿瘤学杂志,2007,5:330-333. [5] 李鹤成,张亚伟,相加庆.胸段食管癌淋巴结转移规律及其对淋巴结清扫方式的影响.中华胸心血管外科杂志,2007,4:252-254. [6] 李成林,王雅棣,孙国贵,等.食管癌二野淋巴结清扫术后复发规律探讨.中华放射肿瘤学杂志,2011,3:118-121. [7] 高宗人,赫捷//食管癌.北京:北京大学医学出版社,2008,4:99-104. [8] Som PM, Curtin HD, Mancuso AA. An imaging based classification for the cervical nodes designed as all adjunct to recent clinically based nodal classifications. Arch Otolaryngol Head Neck Surg,1999,125:388-396. [9] Akiyama H, Tsunimaru M, Udagawa H, et al. Radical lymph node dissection for cancer of the thoracic esophagus. Ann Surg,1994,220:364-372. [10] 毛友生,赫捷,程贵余.我国食管癌外科的现状与外来对策.中华肿瘤杂志,2010,6:401-404. [11] 佘志廉,朱坤寿,柳硕岩,等.胸段食管癌颈部上纵隔淋巴结转移的研究.中国肿瘤临床,1998,7:530-532. [12] 夏李明,陈奇勋,周兴明,等.胸段食管癌喉返神经旁淋巴结转移的影响因素.中国肿瘤,2006,11:782-784. [13] Shimada Y, Sato F, Maeda M, et al. Validity of intraoperative pathological diagnosis of paratracheal lymph node as a strategy forselection of patients for cervical lymph node dissection during egophagectomy. Dis Esophagus,2003,16:246-251. [14] Tabira Y, Kitanmm N, Yoshioka M, et al. Significance of three-field lymphadenectomy for carcinoma of the thoracic esophagus based on depth of tumor infiltration,1ymph nodal involvement and survival rate. J Cariovasc Surg (Torino),1999,40:737-740.
2012, Vol. 21 
