The Analysis Of Influential Factors In Regional Lymph Node Metastasis Of Esophageal Squamous Cell Carcinoma

Background: China is one of the high-incidence areas for esophageal cancer worldwide.Esophageal cancer is the fourth most common cause of cancer deaths in China.More than 90% of esophageal cancer is diagnosed as esophageal squamous cell carcinoma(ESCC)in China.Surgery remains a major component of treatment for localized resectable non-cervical esophageal squamous cell carcinoma.The metastasis of lymph node is an important prognostic factor in ESCC.Objective: The objective of this study was to investigate the influential factors including clinicopathological characteristics,hematological markers and Immunohistochemistry,which can predict lymph node metastasis in ESCC.The accurate assessment and prediction of nodal status are essential for individual therapy.Methods: From October 2004 through October 2017,patients who underwent radical esophagectomy for ESCC were identified at Shandong Cancer Hospital Affiliated to Shandong University,Jinan,China.Using our criteria,a total of 612 patients with T1 or T4 tumors were included in this respective study.The association between clinicopathological factors,hematological markers of SIR,immunohistochemical analysis and nodal status were retrospectively analyzed by univariate and multivariate logistic regression analyses.Odds ratios(ORs)with 95% confidence interval(95% CI)were calculated.All data were analyzed statistically using SPSS 23.0 software(IBM SPSS,Chicago,IL,United States).Results: In the present study,20.1%(56 of 278)of T1 ESCC showed lymph node metastasis,while 66.8%(223 of 334)of T4 ESCC showed lymph node metastasis(Pearson Chi-square test,P<0.001).4.2% of T1 a ESCC showed lymph node metastasis,while 25.7% of T1 b ESCC showed lymph node metastasis(Pearson Chi-square test,P < 0.001).Multivariate analyses of risk factors for lymph node metastasis revealed that tumor length,vascular tumor embolus and CNP were significant predictive factors for nodal metastasis.The immunohistochemical results showed that the tumor with the high expression of CD36,PD-L1 and VEGF-D and low expression of CD8 tend to metastasize to lymph node.Conclusion: The hematological marker of CNP,tumor length and vascular tumor embolus are independent risk factors for nodal metastasis in patients with resected T1 or T4 ESCC without neoadjuvant treatment.The tumor with the high expression of CD36,PD-L1 and VEGF-D and low expression of CD8 may has high risk of lymph node metastasis.The accurate assessment and prediction of nodal status is of great importance for individual combined therapy.