| ObjectiveTo explore a reasonable strategy for superior mediastinal lymph node dissection in thoracic esophageal squamous cell carcinoma,were analyze the risk factors of superior mediastinal lymph node metastasis,establish one prediction model and nomograms for evaluating the risk.The distribution of lymph node metastasis was further analyzed to explore the reasonable range of upper mediastinal lymph node dissection.MethodsAmong 1368 EC patients who underwent thoracolaparoscopic surgery from January 2013 to December 2016 at the Department of Thoracic Surgery of the first affiliated hospital of zhengzhou university,525 cases of pT1-3NxM0 stage of esophageal squamous cell carcinoma were included for this study.The clinical and pathological data includes general information:patient name,sex,age,previous medical history,body mass index,nutritional index;Surgical data:surgical method,dissection range and N stages;Local tumor indicators:tumor site,length,invasion depth,degree of tumor differentiation(G stage),vascular/nerve invasion;The number and group of lymph node dissection stage metastasis.The data using SPSS 25.0 and R3.5.1 software statistical software for processing.Univariate and multivariate logistic regression analyses were used to test the association between the clinicopathologic data and the risk of superior mediastinal lymph node metastasis,then a prediction model and nomograms were established;The differences of metastasis rate between lymph node stations in the superior mediastinal were further compared.P<0.05(bilateral)was statistically significant.ResultsA total of 525 cases were enrolled,including 339 males and 186 females.Age:39~82 years old.Right thoracoscopic radical resection of esophageal cancer and systematic lymph node dissection were performed.Operative methods:ivor-lewis surgery in 18 cases,Mckeown surgery in 507 cases;Lymph node dissection:3FD dissection was performed in 17 cases and 2FD dissection in 508 cases.Superior mediastinal lymph node metastasis:positive in 138 cases,negative in 387 cases;Overall N stage:312 cases in N0 stage,137 cases in N1 stage,54 cases in N2 stage,and 22cases in N3 stage.Univariate and multivariate Logistic regression analysis was performed to analyze the following clinical and pathological factors:gender,age,history of smoking,alcohol and diabetes,weight loss,BMI,and nutrition-related indicators were not risk factors,and the differences were not statistically significant(P>0.05);However,tumor location,length,degree of infiltration and differentiation,and vascular/nerve invasion were not only risk factors for esophageal supramediastinal lymph node metastasis,but also independent risk factors,with statistically significant differences(P<0.05).Then the prediction equation was established,and the AUC of the equation was 0.727,and the Jordan index was 0.37,P<0.05,95%CI(0.681-0.772)were calculated.The possibility of lymph node metastasis was visualized by nomogram with R software.In order to have a more precise choice for superior mediastinal lymph node dissection,we further analyze and compare the superior mediastinal each station on the rate of lymph node metastasis,106 recR group(22.56%)vs 105(5.75%),χ~2=24.016,P<0.01,106 recL(15.14%)vs 106 tbL group(1.94%),χ~2=27.37,P<0.01,significant difference with statistical significance.ConclusionsThe increase of T stage,G stage and tumor length,higher tumor location,and associated vascular/nerve infiltration are independent risk factors for superior mediastinal lymph node metastasis of thoracic esophageal squamous cell carcinoma.The model established by the independent risk factors can accurately predict the risk of superior mediastinal lymph node metastasis.it is feasible and reliable,and can be visually shown by nomograms.In the superior mediastinal region,the closer it is to the cervical root,the higher the lymph node metastasis rate will be.The superior mediastinal lymph node dissection should be performed,but routine dissection of the 106tbL group lymph nodes is not recommended. |
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