| Objective:China has been well recognized as a high incidence area of carcinoma of the thoracic esophagus and esophagogastric junction. Lymph node metastasis (LNM) is the major route for metastasis, and also the main factor affecting the prognosis of patients. In the early-stage study, we have generally studied the carcinoma of esophagus and esophagogastric junction, and reported the LNM and its affecting factors of tumors in different locations. The prognostic analysis indicated that the number of LNM is an independent prognostic factor in patients with carcinoma of esophagus and esophagogastric junction. With the deepening of the study nowadays, some scholars consider that the esophagogastric junction possesses independent biological characteristics. Based on the results of the early-stage study, this study will conduct a separate study of esophagogastric junction carcinoma (EJC) to further explore LNM of carcinoma of the thoracic esophagus and esophagogastric junction and its impact on prognosis, and investigate the relationship between the two kinds of tumors.The study of LNM and its impact on prognosis provides the basis for radical lymph node (LN) dissection and chooses rational comprehensive therapy after operation.Methods:1. Randomly selecting 1574 operated cases of carcinoma of the thoracic esophagus and esophagogastric junction from January 1, 1996 to December 31, 2004 in the Fourth Hospital of Hebei Medical University, and build the Access database about the clinical data of the patients. Rejecting 160 cases of palliative operation and unresected tumors, 1414 cases of radical surgery are obtained as a result, in which contain 886 cases of esophagus carcinoma (EC) and 528 cases of EJC.2. Calculating separately the lymph node metastasis rate and degree, and their relationship between clinical pathological features.3. Stratification by tumor site, invasion depth and clinical stage, and we comparative separately the lymph node metastasis rate, degree of carcinoma of the thoracic esophagus and esophagogastric junction.4. 1414 patients undergone radical surgery were followed up, and 906 cases were visited. For the cases having complete follow-up data, we analyze separately the relationship between LNM and the prognosis of the thoracic EC and EJC. Results were considered to be statistically significant at P<0.05.Result:1 The LNM rates were 36.0% in the EC, 45.8% in the EJC. The LNM degrees were 13.88% in the EC, 31.4% in the EJC.2 Relationship between the rate and degree of LNM and clinical pathological factors2.1 Thoracic ECThe longer of tumor diameter,the lower of tumor position,the deeper of infiltrating depth and the emerge of vas tumor embolus and the state of circumambient organ encroachment, thus the higher rate and degrees of LNM(P<0.05).2.2 EJCThe deeper of infiltrating depth and the emerge of vas tumor embolus and the state of circumambient organ encroachment, thus the higher rate and degrees of LNM(P<0.05).2.3 The difference of LNM between thoracic EC and EJC2.3.1 The relationship between the tumor position and LNM(Table 3)The LNM rate and degrees of different parts of the tumor are considered to be statistical difference at P<0.01. The LNM rate of EJC was notablely higher than the carcinoma of upper and middle thoracic esophagu(sP<0.05), but with no statistical significance between EJC and the lower thoracic EC (P>0.05). The LNM degree of EJC was notablely higher than the carcinoma of upper, middle and lower thoracic esophagus(P<0.01).2.3.2 The relationship between the infiltrating depth and LNM(Table 4)There were statistical significance between the LNM rate and degree of the two kinds of tumors with different depth of infiltration(P<0.01).The Spearman correlation analysis indicated that both of LNM rate and degree were positively correlated to infiltration depth(P<0.01).The LNM rate of the EC invaded superficial muscular layer was notablely higher than that of the EJC(P<0.05), but with no statistical significance between the two kinds of tumors invaded other layers of tissue(P>0.05).The LNM degrees of the two kinds of tumors, which have infiltrated into the deep muscular layer, were no statistical significance(P>0.05). While the LNM degrees of the EJC, which have infiltrated beyond deep muscular layer, was notablely higher than that of the EC(P<0.05).2.3.3 The difference of LNM between thoracic EC and EJC among the same stage(Table 5)The LNM rate of the two kinds of tumors patients in stageâ… orâ…£has no significant difference(P>0.05). The LNM rate of patients in stageâ…¡EJC was notablely higher than thoracic EC(P<0.01),while which in stageâ…¢thoracic EC was notablely higher than EJC(P<0.01).The LNM degrees of the two kinds of tumors patients in stageâ… orâ…¡has no significant difference(P>0.05). The LNM degrees of patients in stageâ…¢thoracic EC was notablely higher than EJC(P<0.01), while which in stageâ…£EJC was notablely higher than thoracic EC(P<0.01)3 The Influence on prognosis of the LNM of thoracic EC and EJC3.1 The Influence on prognosis of the LNM of thoracic EC3.1.1 The 1- year, 3- year, and 5-year survival rate for node-negative patients were 93.16%, 79.94%, 71.72% versus 80.63%, 44.82%, 29.41% for node-positive patients respectively(P<0.01).3.1.2 According to the number of positive LNM, there was significanct difference in survival curves among our suggesting grouping: group 1, node-negative; group 2, one to three nodes; group 3, more than three nodes(P<0.01). The survival curve of node-negative patients was notablely higher than that of group 2 and 3. The survival curve of group 2 was notablely higher than that of group 3. The same conclusion was obtained when introduced into cases of stage T3M0.3.1.3 The 3-year survival rate were 80.38% in 0 LNM degree, 51.36% in 0-20% LNM degree, 40.00% in >20% LNM degree respectively. The 5-year survival rate were 71.92%, 41.46% and 21.60% respectively (p=0.000).3.1.4 For all patients undergone collo-thoraco-abdominal dissection, the 5-year survival rate in different number of LNM field were 71.71% in 0 field, 33.09% in 1 field, 21.64% in 2 fields respectively (p=0.000).3.1.5 According to extent of lymph node dissection, there were no significanct difference in survival curves among collo-thoraco-abdominal dissection group, thoracic dissection group and abdominal dissection group(P>0.05). The same conclusion was obtained when introduced into cases of middle thoracic esophagus(P>0.05).3.1.6 For the EC in stage N1M0, T2N1M0 and T3N1M0, the 1-year, 3-year and 5-year survival rate for negative subcarinal lymph nodes patients were notablely higher than positive subcarinal lymph nodes patients respectively (P<0.01). The lateral cardia LN , left gastric artery LN and lateral esophagus LN didn't influenced the prognosis significantly(P>0.05).3.2 The Influence on Prognosis of the LNM of EJC3.2.1 The 1- year, 3- year, and 5-year survival rate for node-negative patients were 85.29%,61.47%,49.93% versus 79.45%,31.16%,17.09% for node-positive patients respectively(P<0.05).3.2.2 The survival curve in N0 stage patients was notablely higher than that in N1, N2 and N3(P<0.05), while with no significant difference among stage N1, N2 and N3(P>0.05).3.2.3 According to the degree of LNM, there was significant difference in survival curves among our suggesting grouping: 0 LNM degree, 0-50% LNM degree, >50% LNM degree(P<0.01). The survival curve of patients in 0 LNM degree was notablely higher those in 0-50% LNM degree and >50% LNM degree(P<0.05). The survival curve of patients in 0-50% LNM degree was notablely higher than that in >50% LNM degree(P<0.05).3.2.4 The survival curves of different extent of lymph node dissection had no significant difference among collo-thoraco-abdominal dissection group, thoracic dissection group and abdominal dissection group(P>0.05). The same conclusion was obtained when introduced into cases of stageâ…¢and stageâ…£(P>0.05).3.2.5 The survival curves of cases had no significant difference(P>0.05), regardless of whether the lateral cardia LN , left gastric artery LN and lateral esophagus LN metastasis or not.Conclusion:1 Relationship between the rate and degree of LNM and clinical pathological factors1.1 Tumor diameter, tumour location,infiltrating depth, vas tumor embolus and the state of circumambient organ encroachment affect LNM rate and degree of EC (P<0.05), while the gender affects LNM rate only(P>0.05).1.2 Tumor diameter, infiltrating depth, vas tumor embolus and the state of circumambient organ encroachment affect LNM rate and degree of EJC (P<0.05), while the age affects LNM degree only(P>0.05).1.3 There were statistical significance between the LNM rate and degree of the two kinds of tumors in same stage and at the same infiltration depth ( P<0.01 ) . The biological characteristics of two types of tumor exist significant differences, so we shoud study them respectively.2 The Influence on prognosis of the LNM of thoracic EC and EJC2.1 The number of positive lymph nodes, the LNM degrees and number of LNM fields are important influence factors of esophageal cancer prognosis.2.2 The study on the extent of lymphnode dissection in the resection of thoracic EC shows that the survival curves among collo-thoraco-abdominal dissection group, thoracic dissection group and abdominal dissection group were no significant difference. Further study is needed to confirm this conclusion.2.3 For the EC in stage (N1M0, T2N1M0 and T3N1M0), whether subcarinal LNM metastasis or not influenced the prognosis significantly, while the lateral cardia LN , left gastric artery LN and lateral esophagus LN didn't. Thus, subcarinal LNM should he removed.2.4 LNM degree is an important indicator of prognosis of EJC.2.5 The study on extent of lymph node dissection of EJC shows that the survival curves had no significant difference among collo-thoraco-abdominal dissection group, thoracic dissection group and abdominal dissection group. Further study is needed to confirm this conclusion.2.6 For the EJC (â…¢andâ…£stage), the lateral cardia LN , left gastric artery LN and lateral esophagus LN didn't influence the prognosis significantly.
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