食管鳞癌侵犯粘膜下层与淋巴结转移规律研究

发布时间：2018-05-01 19:10

本文选题：食管鳞癌 + 粘膜下层　；参考：《南京医科大学》2016年博士论文

【摘要】：背景食管癌发病率逐年上升,其5年生存率仅为15%-25%,为了提高生存率,关注点应在早期食管癌。内镜治疗越来越多应用于早期食管癌患者,然而,粘膜下层的患者是否适合内镜治疗仍有争议,国内这方面研究很少。我们研究粘膜下层浸润深度对淋巴结转移的影响。方法回顾性收集2009、11月-2014、3月共258例侵犯食管癌粘膜下层患者资料。记录患者人口学资料、肿瘤特征资料和手术信息。由病理科医生把粘膜下层重新分成三等分：浅1/3(sml),中1/3(sm2)和深1/3(sm3)。我们比较不同浸润深度肿瘤的特征和手术特点；通过单因素和多因素分析,研究肿瘤特征和淋巴结转移的关系；比较不同浸润深度远处脏器转移的不同；通过COX单因素和多因素分析研究全因死亡率的高危因素。进一步,我们研究不同浸润深度、有无淋巴血管侵犯和不同分化程度对淋巴结转移、肿瘤复发和死亡的影响；最后,我们选择sml中的“低危”患者(内镜下大体形态为平坦型,无淋巴血管侵犯、高、中分化的患者),观察其预后情况。结果所有患者中sm1 75(29.1%)例,sm2 73(28.3%)例,sm3 110(42.6%)例,其淋巴结转移率分别为12%(9/75),11%(8/73),20.9%(23/110)。单因素分析发现sm3可能与淋巴结转移有关(P=0.041)。多因素分析发现,肿瘤体积1.856 cm3(P=0.022)和淋巴血管浸润阳性(P=0.004)是淋巴结转移的独立危险因素。COX回归分析显示浸润深度不是全因死亡的高危因素,而淋巴结转移是全因死亡的高危因素。最后,12例“低危”患者纳入观察,其中只有1例患者死亡。结论侵犯粘膜下层的食管癌患者均伴有大量淋巴结转移,对于sml"低危”患者,可选择内镜治疗,但因病例数少,还需要大样本研究验证该结果。
[Abstract]:Background the incidence of esophageal cancer is increasing year by year, and the 5-year survival rate is only 15-25. In order to improve the survival rate, the focus should be on early esophageal cancer. Endoscopic therapy is more and more used in patients with early esophageal cancer. However, whether submucosal patients are suitable for endoscopic therapy is still controversial. We studied the effect of depth of submucosal infiltration on lymph node metastasis. Methods 258 patients with submucous invasion of esophageal carcinoma were collected retrospectively. Patient demographics, tumor features and surgical information were recorded. The submucosa was subdivided into three parts by a pathologist: a shallow 1 / 3 smlum, a middle 1 / 3 Sm 2) and a 1 / 3 Sm 3. We compared the characteristics and surgical features of tumors with different invasive depths, studied the relationship between tumor characteristics and lymph node metastasis by univariate and multivariate analysis, and compared the differences of distant organ metastasis with different invasive depths. The high risk factors of all-cause mortality were studied by COX single factor and multivariate analysis. Further, we studied the effects of different depth of infiltration, lymphatic invasion and differentiation on lymph node metastasis, tumor recurrence and death. No lymphatic vessel invasion, high, moderate differentiation of patients, to observe the prognosis. Results of all the patients, sm1 75 (29.1) and Sm 273,28.3) were involved. The lymph node metastasis rate of the patients was 12.9% 75% and 20.9% respectively. The lymph node metastasis rate was 23 / 1100.The lymph node metastasis rate of all the patients was 12.9%, and the lymph node metastasis rate was 20. 9% and 20. 9% respectively, and the lymph node metastasis rate was 23 / 110%. Univariate analysis showed that sm3 might be related to lymph node metastasis. Multivariate analysis showed that tumor volume (1.856 cm ~ 3) and lymphatic vascular invasion positive (P _ (0.004) were independent risk factors for lymph node metastasis. Cox regression analysis showed that depth of invasion was not a risk factor for death, but lymph node metastasis was a risk factor for all death. Finally, 12 low-risk patients were included in the study, of which only 1 died. Conclusion all patients with submucosal esophageal carcinoma are accompanied with a large number of lymph node metastases. For the patients with "low risk" of sml, endoscopic treatment can be chosen, but due to the small number of cases, large sample research is needed to verify the results.
【学位授予单位】：南京医科大学
【学位级别】：博士
【学位授予年份】：2016
【分类号】：R735.1

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