| Research background and purpose:Esophageal cancer(EC)is the most frequently occurring tumor of digestive tract tumors.With the development of treatment methods,the survival time of EC patients after comprehensive treatment has not reached satisfactory results.Lymph node metastasis(LNM)is the main mode of treatment failure in EC patients.For upper EC patients,radiotherapy is the main treatment method.The main part of LNM is the lower neck and upper mediastinum.This is the main area of radiation prevention for radiotherapy.Currently,for lower neck lymph nodes(LN)drainage area is not clearly defined and can be further studied.Moreover,the risk factors for LNM have not been studied in the lower neck of these patients with esophageal squamous cell carcinoma(ESCC).This retrospective study will collect patients in our hospital to explore patients with EC in the upper and lower thoracotomy,analyze the risk factors of LNM in the lower neck,and obtain the distribution range and regularity of the LNM position in the lower neck.Materials and Methods:We collected 314 patients with esophageal squamous cell carcinoma who came to our hospital for diagnosis and treatment from January 2012 to October 2019,and selected 314 patients based on the inclusion and exclusion criteria.The basic clinical characteristics and related information of esophageal cancer were collected,and the patients’ lower neck,mediastinum,and abdomen LNM were recorded,and finally the clinical and tumor factors were analyzed.According to the imaging data of each patient at the time of initial diagnosis,a lymph node map was drawn,and the target area was delineated.Result:1.Univariate analysis showed that age,place of residence,N stage,clinical stage,positive mediastinal lymph nodes in groups 2,4,and 6 were related to LNM in the lower neck,all P<0.05.Multivariate logistic regression analysis showed that age,gender,N stage,mediastinum 2 and 4 positive lymph nodes were independent risk factors for lower cervical LNM,P <0.05.2.A total of 314 EC patients were included in the study through the inclusion and exclusion criteria,of which 105 were in the cervical segment,accounting for 33.4%,and 209 were in the upper chest,accounting for 66.6%.There were 182 cases of lower neck LNM,accounting for 58.0% of the total.In the lower neck LN,the highest LNM rate in group 101 was 44.0%,followed by 104 supraclavicular LN,which was 24.9%.Cervical EC metastasis rates are 101(47.1%),104(28.8%),100sm(8.7%),102(8.7%),103(3.8%),100ac(2.9%)in descending order;upper chest EC The order of LNM rate of lower neck was 101(42.2%),104(22.6%),102(13.3%),100ac(9.2%),100sm(6.9%),103(5.8%).Conclusion:1.Age,gender,N stage,mediastinum 2,4 groups positive lymph nodes were independent risk factors for lower cervical LNM.2.For any stage of cervical and upper chest EC patients,it is recommended that101(near the esophagus of the neck)and 104(the supraclavicular LN)be included in the scope of radiation prevention.3.Recommended target area for the lower neck: circular cartilage as the upper boundary,the thorax entrance as the lower boundary,the outer edge of the trachea as the inner boundary,the inner boundaries of the sternocleidomastoid muscle / clavicle on both sides as the outside world,and the posterior boundary of the sternocleidomastoid muscle as the rear When the sternocleidomastoid muscle disappears,the outside is gradually retracted to the medial edge of the internal jugular vein(the right side is the medial edge of the innominate vein). |
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