食管癌根治术后腹腔淋巴结复发区域对术后放疗靶区确定的指导意义

doi:10.3760/cma.j.issn.1004-4221.2016.02.004

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摘要目的分析胸段食管鳞癌根治术后腹腔淋巴结复发区域,探讨术后辅助放疗靶区的设计。方法对2005—2013年间我院收治的胸段食管鳞癌R₀根治术后经影像学检查证实术后有腹腔淋巴结转移患者,按第7版AJCC胃癌分组标准对腹腔淋巴结转移具体部位分组并进行回顾分析。组间差异行χ²检验。结果 1593例中术后腹腔淋巴结转移148例,总转移率为9.3%,其中食管胸上、中、下段腹腔淋巴结转移率分别为2.3%、7.8%、26.6%(P=0.000),术后病理为T₁+T₂、T₃+T₄期的分别为8.7%、9.5%(P=0.601),术后病理淋巴结转移为0~2、≥3个的分别为4.8%、20.1%(P=0.000)。腹腔淋巴结转移率从高到低依次为腹主动脉旁的16a2、16a1、腹腔干、胰头后及肝总动脉转移率分别为64.9%、41.2%、37.8%、32.4%、20.9%,其总转移率为91.9%。结论食管癌根治术后腹腔淋巴结转移主要部位是腹主动脉旁16a2和16a1、腹腔干、胰头后以及肝总动脉淋巴结引流区,是术后辅助放疗的腹腔靶区。

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关键词 ：食管肿瘤/外科学, 淋巴结转移, 食管肿瘤/放射疗法, 靶区
, , , 基金项目:福建省自然科学基金项目(2012J01331、2015J01377), 福建省临床重点专科建设项目(2012)

Abstract：Objective To analyze the regions of abdominal lymph node metastasis in recurrent thoracic esophageal squamous cell carcinoma (TE-SCC) after radical surgery, and to guide the design of target volume in postoperative adjuvant radiotherapy. Methods Patients with TE-SCC who were admitted to our hospital from February 2005 to April 2013 were enrolled as subjects. All patients were diagnosed with abdominal lymph node metastasis by imaging after R₀ radical surgery. The exact regions of abdominal lymph node metastasis were classified according to the 7^th edition of American Joint Committee on Cancer (AJCC) TNM staging system for gastric cancer, and then retrospectively analyzed. The difference of two group was analyzed by χ² test. Results Among the 1593 eligible patients, 148(9.3%) were diagnosed with abdominal lymph node metastasis after surgery. In the 148 patients, the abdominal lymph node metastasis rates in the upper, middle, and lower thoracic esophagus were 2.3%, 7.8%, and 26.6%, respectively (P=0.000);the incidence rates of pathological stages T_1/2 and T_3/4 were 8.7% and 9.5%, respectively (P=0.601);the incidence rates of 0-2 and ≥3 metastatic lymph nodes in postoperative pathological examination were 4.8% and 20.1%, respectively (P=0.000). The abdominal lymph node metastasis rate was the highest in the para-aortic lymph node (16a2), followed by para-aortic lymph node (16a1) and the lymph nodes around the celiac trunk, posterior area of the pancreatic head, and common hepatic artery (64.9%, 41.2%, 37.8%, 32.4%, and 20.9%), yielding an overall metastasis rate of 91.9%. Conclusions The major regions of abdominal lymph node metastasis in esophageal carcinoma after radical surgery include para-aortic lymph nodes (16a2 and 16a1) and the lymph nodes around the celiac trunk, posterior area of the pancreatic head, and common hepatic artery. These regions are the abdominal target volumes of postoperative adjuvant radiotherapy.

Key words： Esophageal neoplasms/surgery Lymph node metastasis Esophageal neoplasms/radiotherapy Target
Fund program:Natural Science Fund Project in Fujian Province (2012J01331,2015J01377) The Construction Project of Key Clinical Specialty in Fujian Province (2012)

收稿日期: 2015-05-14

引用本文:

. 食管癌根治术后腹腔淋巴结复发区域对术后放疗靶区确定的指导意义[J]. 中华放射肿瘤学杂志, 2016, 25(2): 105-108.

. Significance of regions of abdominal lymph node metastasis for target volume delineation in postoperative radiotherapy for patients with recurrent esophageal carcinoma after radical surgery[J]. Chinese Journal of Radiation Oncology, 2016, 25(2): 105-108.

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