[摘 要] 背景 早期食管癌的治疗，内窥镜技术的发展为其治疗提供了一种新的选择，但内窥镜技术尚无法完成淋巴结的清扫，有其局限性。因而施行外科手术或者内窥镜治疗前评估肿瘤的淋巴结转移风险是必要的。目的 本研究旨在分析早期食管鳞癌（T1）的淋巴结转移危险因素及评估其风险。方法 回顾性分析167例早期食管鳞癌患者的病例治疗及病理报告，其中133例无淋巴结转移的病例作为对照组（N0），有淋巴结转移的34例病例作为实验组（N1）。进行肿瘤标本的镜下检查，将T1食管鳞癌浸润深度分为六层（M1、M2、M3、SM1、SM2、SM3）并对淋巴结转移因素进行分析。结果 单因素LOG回归分析显示肿瘤浸润深度、长度、分化程度是影响淋巴结转移的危险因素，多因素LOG回归分析显示肿瘤浸润深度（p=0.046）、长度（p=0.046）、分化程度（p=0.021）是影响淋巴结转移的独立危险因素（p<0.05）。结论 T1食管鳞癌患者的淋巴结转移影响因素较多，对于浸润较深，肿块较大，分化程度较差的肿瘤，其易发生淋巴结转移，外科手术应继续作为标准治疗方法。
[Abstracts] Background Endoscopic technology provide a new choice for the therapy for early esophageal carcinoma, but it is Unable to complete lymph node cleaning . So it is definitely necessary to assess risk of lymph node metastasis before screening patients to have an operation or endoscopic therapy. Objective The aim of this study was to analysis risk factors for lymphatic metastasis in T1 esophageal squamous carcinoma and evaluate its risk. Methods Cases and pathological reports of 167 T1 esophageal squamous carcinoma were retrospectively analyzed, 133 patients(group N0) had no lymph node metastasis seen as control group and 34 patients(group N1) had lymph node metastasis seen as experimental group. Tumor specimens were reevaluated for overall submucosal layer thickness, tumor length, depth of tumor infiltration as well as lymphatic and vascular infiltration. Depth of submucosal tumor infiltration was divided in six layer (M1、M2、M3、SM1, SM2, SM3) and factors influencing lymphatic metastasis were assessed. Results Univariate logistic regression analysis showed depth of tumor infiltration, tumor length and tumor differentiation were risk factors influencing lymphatic metastasis formation. Variate logistic regression analysis showed depth of tumor infiltration（p=0.046）, tumor length（p=0.046） and tumor differentiation（p=0.021） were independent risk factors influencing lymphatic metastasis formation(p<0.05). Conclusion Lymphatic metastasis risk of T1 esophageal squamous carcinoma is high and influencing factors is more, so esophagectomy should sequentially be the standard treatment for T1b patients prone to lymphatic metastasis.
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