表浅食管鳞癌淋巴结转移规律探讨

目的根据外科食管癌根治术后病理结果，分析表浅食管鳞癌淋巴结转移情况，预测T1期食管鳞癌淋巴结转移的可能性及内镜下治疗的可行性。方法回顾性分析344例行食管鳞癌根治术并经病理确诊的早期食管鳞癌患者的临床资料，比较有/无淋巴结转移早期食管鳞癌患者的临床病理特征，对其与淋巴结转移的相关性进行单因素、多因素分析,估计淋巴结转移的风险。结果单因素分析显示：肿瘤大小( P=0.004)、浸润深度( P=0.009)、分化程度( P=0.030)和淋巴管肿瘤浸润(( P=0.002)与淋巴结转移有关；多因素分析结果显示肿瘤直径( P=0.007)、浸润深度( P=0.003)、分化程度( P<0.050)和淋巴管肿瘤侵润( P<0.001)为淋巴结转移的独立危险因素。结论肿瘤直径<3 cm的高/中分化黏膜内鳞癌患者淋巴结转移风险小，有行内镜切除术的绝对适应证；肿瘤直径≥3 cm的高、中、低分化黏膜内鳞癌患者淋巴结转移风险大，如行内镜切除术,需关注术后病理及随访。

英文摘要:

Objective To identify the pathological features of superficial esophageal carcinoma and esophageal intraepithelial neoplasia resected through endoscopic submucosal dissection (ESD). Methods The clinical and pathologic profiles of 130 cases were reviewed, including gross type, histology type, infiltration depth, infiltrative growth pattern, presence of tumor budding, lymphatic and vascular invasion, and margin status. Results The patients had a median age of 62 years old. The predominant gross type was mixed type (78/130,60.0%), followed by Type 0-Ⅱ(49/130,37.7%). The longest diameter of lesionshad a median of 13.8 mm. Morphologically, there were 3 cases (2.3%) of undetermined dysplasia, 25 cases (19.2%) of low grade intraepithelial neoplasia, 56 cases (43.1%) of high grade of intraepithelial neoplasia, and 46 cases(35.4%) of invasive carcinoma. No correlation was found between histological type and gross type. Intramucosal and submucosal invasive carcinoma accounted for 87.0% (40/46) and 13.0% (6/46) of the cases, respectively; sm1 and sm2 accounted for 4.3%(2/46) and 8.7%(4/46) of the cases, respectively. Infiltrative growth pattern was identified as infiltrative growth pattern (INF)a (23/46, 50.0%), INFb (17/46, 37.0%) and INFc (6/46, 13.0%). Tumor budding was found in 3 cases and lymphatic and vascular invasion was found in 2 cases.Margin was positive in 30 cases (23.1%). Invasive carcinomahad a higher margin positive rate (24/46, 52.1%） than low grade intraepithelial neoplasia (1/25, 4.0%)

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