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目的对腺癌侵及食管壁深度与淋巴结转移的关系以及淋巴结转移对预后的影响进行分析研究。方法澳大利亚弗林德斯大学医学中心自1985年～2003年,手术治疗食管腺癌121例。其中男101例,女20例。年龄36～80岁,平均62岁。本组手术切除率为96.7%(117/121例)。手术清扫淋巴结的数目每例为2～30个,平均8个。无淋巴结转移59例(48.8%)、有淋巴结转移62例(51.2%)。本组病例全部得到随访。结果当肿瘤位于黏膜层或黏膜下层(T1)时,淋巴结转移的发生率为22.2%(10/45例)、平均淋巴结转移的个数为0.3个、>4个淋巴结转移的比例为0(0/45例);当肿瘤侵及食管周围组织(T4)时,淋巴结转移的发生率为85.7%(6/7例)、平均淋巴结转移的个数为5.1个、>4个淋巴结转移的比例为71.4%(5/7例),P<0.05。无淋巴结转移组的5年生存率为52.9%、1～4个淋巴结转移组的5年生存率为11.5%、>4个淋巴结转移组的5年生存率为0,P<0.01。结论肿瘤对食管壁侵及深度和淋巴结转移的发生率及淋巴结转移的数量之间存在正相关性。随着肿瘤对食管壁侵及深度的增加,淋巴结转移的发生率、平均淋巴结转移的数量和>4个淋巴结转移的比例均增加。有无淋巴结转移和淋巴结转移的数量是影响远期生存率的一个重要因素。
Objective To study the relationship between the invasion of adenocarcinoma and the depth of esophageal wall and lymph node metastasis and the impact of lymph node metastasis on the prognosis. Methods Flinders University Medical Center in Australia from 1985 to 2003, surgical treatment of esophageal adenocarcinoma in 121 cases. There were 101 males and 20 females. Age 36 to 80 years old, average 62 years old. The surgical resection rate was 96.7% (117/121 cases). The number of surgical dissection lymph nodes in each case is 2 to 30, an average of 8. No lymph node metastasis in 59 cases (48.8%), there were 62 cases of lymph node metastasis (51.2%). All patients were followed up. Results The incidence of lymph node metastasis was 22.2% (10/45) when the tumor was located in mucosa or submucosa (T1), the average number of lymph node metastasis was 0.3 and the rate of> 4 lymph node metastasis was 0 (0 / 45 cases). When the tumors invaded the surrounding tissues of the esophagus (T4), the incidence of lymph node metastasis was 85.7% (6/7 cases), the average number of lymph node metastases was 5.1, the proportion of> 4 lymph node metastases 71.4% (5/7 cases), P <0.05. The 5-year survival rate was 52.9% in non-lymph node metastasis group, 11.5% in 1 ~ 4 lymph node metastasis group, and 0% in> 4 lymph node metastasis group (P <0.01). Conclusion There is a positive correlation between the incidence of esophageal wall invasion and the incidence of lymph node metastasis and the number of lymph node metastases. With the increase of tumor invasion and esophageal wall depth, the incidence of lymph node metastasis, the average number of lymph node metastases and the proportion of> 4 lymph node metastases increased. The presence or absence of lymph node metastases and lymph node metastases is an important factor affecting the long-term survival rate.