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目的探讨食管鳞癌患者淋巴结转移的特征、影响因素及其对生存的影响,为指导临床规范治疗提供依据。方法对299例食管鳞癌根治术患者的临床病理资料进行回顾性分析。结果 (1)不同肿瘤部位、最长径、T分期,淋巴结转移差异均有统计学意义(均P<0.05),淋巴结转移率由高到低依次是胸下段、胸中段、胸上段,随肿瘤最长径、T分期增高而增高。(2)肿瘤最长径<3 cm和3~5 cm;Tis+T1期和T2期淋巴结转移风险较小(均P<0.05)。(3)本组患者1、3、5年生存率分别为87%、69%和49%。N0、N1患者生存期显著优于N3患者(均P<0.05)。分层生存期成对比较,N0患者生存最好,N3最差。(4)G2期患者死亡风险是G1期的2.168倍;N3期患者死亡风险是N0期的3.57倍。结论食管鳞癌患者淋巴结转移与肿瘤部位、最长径和T分期有关;肿瘤最长径大和高T分期淋巴结转移风险较大;分化较差、淋巴结转移数多,患者预后较差。
Objective To investigate the characteristics, influencing factors and survival of esophageal squamous cell carcinoma in patients with lymph node metastasis and provide the basis for clinical normative treatment. Methods The clinical and pathological data of 299 patients with esophageal squamous cell carcinoma underwent radical surgery were retrospectively analyzed. Results (1) There were significant differences in tumor location, longest diameter, T stage and lymph node metastasis (all P <0.05). The rates of lymph node metastasis from high to low were in the chest, middle and upper thoracic segments, Longest diameter, T staging increased and increased. (2) The longest tumor diameter was less than 3 cm and 3 ~ 5 cm, and the risk of lymph node metastasis was lower in Tis + T1 and T2 (all P <0.05). (3) The 1, 3, 5-year survival rates of patients in this group were 87%, 69% and 49% respectively. Patients with N0 and N1 had significantly better survival than those with N3 (all P <0.05). Hierarchical survival paired comparison, N0 patients had the best survival, N3 worst. (4) The risk of death in G2 phase is 2.168 times of that in G1 phase. The risk of death in N3 phase is 3.57 times of that in N0 phase. Conclusions Lymph node metastasis in esophageal squamous cell carcinoma is related to tumor location, longest diameter and T stage. The longest tumor diameter and high T stage lymph node metastasis are more risky. The poorly differentiated and more lymph node metastasis patients have worse prognosis.