Prognostic Analysis Of Unexpected And Clinical Lymph Node Metastasis Patients With Thoracic Esophageal Squamous Cell Carcinoma

ObjectivesThe prognosis of recurrence,metastasis and long-term survival in unexpected lymph node metastasis and clinical lymph node metastasis patients with thoracic esophageal squamous cell carcinoma(TESCC)were compared and analyzed.MethodsThe clinical data of patients undergoing radical resection of esophageal cancer in thoracic surgery from February 2014 to October 2016 in Department of thoracic surgery of the Affiliated Cancer Hospital of Zhengzhou University were retrospectively collected.Main inclusion criteria:age≥18 years and ≤ 80 years;TESCC;postoperative pathology identified as lymph node metastasis;R0 resection.The preoperative enhanced CT examination was used to stage the enrolled patients to determine the clinical N stage(cN).Patients with preoperative clinical diagnosis of negative lymph node metastasis(cN0)and postoperative pathological diagnosis of positive lymph node metastasis(pN+)were defined as patients with unexpected pN+.Patients with preoperative clinical diagnosis of positi ve lymph node metastasis(cN+)and postoperative pathological diagnosis of positive lymph node metastasis(pN+)were defined as clinical pN+patients.Clinical and pathological characteristics,recurrence and metastasis were compared between the two groups of patients with unexpected N+stage and clinical N+.The survival curves of the two groups were plotted and compared,and the prognostic factors of lymph node-positive TESCC patients were determined by univariate and multivariate analysis.ResultsAccording to the criteria for inclusion and exclusion,a total of 407 TESCC patients with pN+were included.There were 281 patients with unexpected pN+and 126 patients with clinical pN+.There was no significant difference in gender,age,surgical approach,tumor depth,tumor location,tumor differentiation degree and postoperative adjuvant therapy between the two groups(P>0.05),but patients in the unexpected group had lower lymph node status and pathological stage than those in the clinical group(P<0.05).The overall recurrence and metastasis rate of patients with unexpected pN+was lower than that of patients with clinical pN+(53.4%VS 69.0%),and the difference was statistically significant(P=0.003).Survival analysis showed that the one-year and three-year disease-free survival rates were 80.5%and 46.0%in patients with unexpected pN+,67.3%and 29.7%in patients with clinical pN+,respectively.The disease-free survival rate of patients with unexpected pN+was significantly higher than that of patients with clinical pN+(P<0.001).The one-year and three-year overall survival rates were 91.0%and 62.8%in patients with unexpected pN+、and 82.5%and 48.8%in patients with clinical pN+.The overall survival rates in patients with unexpected pN+were significantly higher than those in patients with clinical pN+(P<0.001).The results of multivariate analysis showed that the deeper the tumor invasion(P<0.001),the higher the number of metastatic lymph nodes(P<0.001)and the cN+stage(P=0.011)were independent risk predictors for disease-free survival of TESCC patients.The deeper the tumor invasion(P<0.001),the higher the number of metastatic lymph nodes(P<0.001),the cN+stage(P=0.047)were independent risk factors for the overall survival of TESCC patients,while the postoperative adjuvant treatment(P=0.019)was an independent protective factor for the overall survival of TESCC patients.ConclusionsUnexpected lymph node metastasis TESCC patients had better prognosis of recurrence,metastasis and long-term survival than clinical lymph node metastasis patients.