| Background: Around the world,There are more than a half of patients with esophageal cancer in China,and squamous cell carcinoma accounts for 90% of esophageal cancer.Esophageal cancer originates from the epithelial cells.Once the submucosa is invaded,lymph node metastasis may occur.Surgery is the main treatment of the esophageal cancer while regional lymph node dissection is one of the standardized surgical treatment measures for esophageal cancer,as well as an important basis for postoperative pathological staging of esophageal cancer and an objective standard for postoperative adjuvant therapy.Most scholars pay attention to the pattern of lymph node metastasis.However,there are few studies on diaphragmatic nodes metastasis for patients with esophageal cancer in China,and the necessity of standardized diaphragmatic nodes resection has not been fully confirmed.The main purpose of this study was to investigate the risk factors for diaphragmatic nodes metastasis in patients with thoracic esophageal squamous cell carcinoma and the impact of diaphragmatic nodes metastasis on the prognosis of patients.Methods: Between January 2016 and December 2019,there are 498 patients underwent radical esophagectomy（at least two-field lymph node dissection）in the First Affiliated Hospital of Anhui Medical University.All clinicopathological data were collected.Inclusion criteria includes patients who:（1）was histologically confirmed primary thoracic esophageal squamous cell carcinoma;（2）underwent standard lymph node dissection（at least two-field lymph node dissection including diaphragmatic nodes）;（3）has complete medical records,including detailed surgical records and postoperative pathological report.Exclusion criteria includes patients who:（1）had other malignant disease;（2）received neoadjuvant therapy;（3）had basic disease of the heart,liver,brain,lung,kidney and other important organs;（4）was not histologically confirmed squamous cell carcinoma;（5）underwent palliative surgery;（6）was confirmed by endoscopy that the distance between the tumor and the incisors less than 20 cm or longer than 40 cm.Finally,the pathological results of surgical specimens and clinical data of all patients were retrospectively analyzed.The independent sample T test,Chi-square test and sum of rank test were actualized for correlation analysis of continuous variables and categorical variables respectively.Cox regression model was used for multivariate analysis.Survival was calculated by the Kaplan-Meier method,and the log-rank test was used to assess differences in survival between groups.A two sided p<0.05 was considered statistically significant.All enrolled patients were followed by telephone or outpatient examination until their death or the time of the study.Follow-up was terminated on April 15,2021.Results: A total of 124 patients were enrolled in this study,of whom 10 patients（8.1%）had diaphragmatic nodes metastasis.Univariate analysis suggested that vascular tumor embolus presence（P =0.024）,which was an independent risk factor for diaphragmatic nodes metastasis.Multivariate analysis showed that diaphragmatic nodes metastasis（P=0.041）,maximum tumor diameter（P=0.009）,vascular tumor embolus presence（P=0.003）,p TNM stage（P<0.001）,N stage（P<0.001）,T stage（P=0.022）were influential factors for prognosis.Diaphragmatic nodes metastasis（P=0.044）and N stage（P<0.001）were independent risk factors for prognosis.The 3-year cumulative survival of patients with diaphragmatic nodes metastasis（36.0%）was significantly lower than that of patients without metastasis（67.6%）.The difference was statistically significant（P=0.02）.Conclusions: This study demonstrated that vascular tumor embolus presence was an independent risk factor for diaphragmatic nodes metastasis.N stage and diaphragmatic nodes metastasis were independent risk factors for poor prognosis.Diaphragmatic nodes metastasis indicated a poor prognosis in patients. |
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