文献类型：期刊文献

中文题名：SiewertⅡ型和Ⅲ型食管胃结合部腺癌脾门区淋巴结转移特点及预后分析

英文题名：Characteristics of splenic hilar lymph node metastasis and prognostic impact in cases with Siewert type Ⅱ and Ⅲ adenocarcinoma of esophagogastric junction

作者：弥海宁[1];杨言苹[2];王涛[1];赵晓宁[1]

第一作者：弥海宁

机构：[1]甘肃省肿瘤医院胃肠外科,甘肃兰州730050;[2]甘肃中医药大学附属医院麻醉科,甘肃兰州730000

第一机构：甘肃省肿瘤医院胃肠外科,甘肃兰州730050

年份：2017

卷号：24

期号：20

起止页码：1460

中文期刊名：中华肿瘤防治杂志

外文期刊名：Chinese Journal of Cancer Prevention and Treatment

收录：CSTPCD;;Scopus;北大核心:【北大核心2014】；

语种：中文

中文关键词：食管胃结合部腺癌;淋巴结转移;淋巴结清除;预后

外文关键词：adenocarcinorna of esophagogastric junction;lymph node metastasis;lymph node dissection; prognosis

摘要：目的近年来食管胃结合部腺癌(adenocarcinoma of esophagogastric junction,AEG)发病率逐年增高。本研究探讨SiewertⅡ型和Ⅲ型AEG脾门区淋巴结(No.10和No.11d)转移的危险因素及其对预后的影响,为制订合理的外科治疗方案提供临床依据。方法回顾性分析2010-01-01—2011-12-30甘肃省肿瘤医院胃肠外科收治的117例经腹入路行胃癌D2或D2+根治术的SiewertⅡ型和Ⅲ型AEG患者的临床资料,根据术后病理检查按有无脾门区淋巴结转移分为阴性组(99例)和阳性组(18例),分析该区淋巴结转移的危险因素及其对预后的影响。结果全部患者脾门区淋巴结转移率为15.4%(18/117);淋巴结转移度(阳性淋巴结数/清除的淋巴结总数)为12.0%(56/465),No.10和No.11d淋巴结转移度分别为9.4%(26/278)和16.0%(30/187)。联合脾脏切除病例(38例)和未行联合脾脏切除病例(79例)脾门区淋巴结转移度分别为13.5%(26/192)和11.0%(30/273),平均每例患者淋巴结清除数量分别为5.1枚和3.5枚,差异均无统计学意义,均P值>0.05。多因素回归分析结果显示,肿瘤大小、浸润深度、No.4sa、4sb和9组淋巴结转移是脾门区淋巴结转移的独立危险因素,P<0.05。阴性和阳性组的5年生存率分别为19.2%和5.6%,差异有统计学意义,χ2=12.822,P<0.001。结论对于肿瘤直径>5cm、T4期、术中发现No.4sa、4sb和9组淋巴结转移的患者,应该彻底清除脾门区(No.10和No.11d)淋巴结,但不建议常规切除脾脏联合行脾门区淋巴结清除。
OBJECTIVE In recent years, the adenocarcinoma of esophagogastric junction incidence increased year by year. To explore the risk factors of splenic hilar lymph node（No. 10 and No. 11d） metastasis and its influence on progno sis in cases with Siewert type II and III adenocarcinoma of esophagogastric junctlon（AEG）, to provide clinical basis for reasonable surgical treatment. METHODS The clinical data of 117 patients with Siewert type II and III adenocarcinoma of esophagogastric junction underwent transabdominal approach D2 or D2＋ radical gastrectomy from January 2010 to I）e cember 201l in the Department of Gastrointestinal Oncology Surgery of Gansu Provincial Cancer Hospilal were recrospec tively analyzed, According to splenic hilar lymph node metastasis by the postoperative pathologic examination,they were divided into negative（99 cases） and positive（18 cases） groups,analyzing the risk factors for splenic hi lar lymph node me tastasis and its influence on prognosis. RESULTS All patients with the splenic hilar lymph node metastasis rate（number of patients with lymph node metastasis /total patients） was 15.4%（18/117）,the overall ratio of metastatic lymph nodc （ number of positive lymph nodes/total number of lymph nodes resected） in the splenic hilum was 12.0% （ 56/465 ）, while the positive ratios of No. 10 and No. 11d lymph nodes were 9. 4%（26/278） and 16.0%（30/187）,respectively. When corn paring patients underwent combined spIenectomy（38 cases） and those who did not undergo combined splenectomy （79 cases）, the ratios of metastatic lymph node in the splenic hilum were 13.5 % （26/192） and 11.0 % （30/273） respee lively, the average number of the lymph node resected each patient were 5. 1 and 3.5 respectively, there were no stalistically significant difference（P〉0.05）. Multivariable logistic regression analysis showed that tumor size, depth of tumor invasion, positive metastasis of No. 4sa,4sb,9 lymph node were independent risk factors for lymph node metastasis in the splenic hilum region（P〈0.05）. The 5-year survival rates of negative and positive groups were 19.2% and 5.6% respec tively with significant difference（χ^2 =12. 822, P〈0. 001）. CONCLUSIONS No. 10 and No. lld LN should be reseeted thoroughly in cases with tumor diameter ≥5 cm, T4, lymph nodes（No. 4sa, 4sb, 9） metastasis, but for early AEG, found no lymph node metastasis in the splenic hilum region,they may not be resected. Combined splenectomy is not recommended for resecting splenic hilar lymph node.