Study On The Characteristics Of Lymph Node Metastasis And The Influencing Factors In Thoracic Esophageal Sequamous Cell Carcinoma

Objective:The purpose of this study was to investigate the lymph node metastasis characteristics in thoracic esophageal sequamous cell carcinoma,and analyze the influencing factors, so can provide reference for the delineation of radiotherapy target.Methods:Clinicopathologic data from319 patients with thoracic esophageal sequamous cell carcinoma who underwent surgical treatment from December 2008 to December 2014 were analyzed retrospectively. This thesis focused on the the 1ymph node metastasis pattern and the relationship between1 ymph node metastasis and the tumor location,tumor length,depth of invasion, pathological grade, vessel invasion.Results:1. The whole group of 319 cases, the lymph node metastatic rate was48.90%(156/319). A total of 3581 lymph nodes were dissected with an average of 11 lymph nodes in each case. The metastatic ratio of lymph node was 15.70%(562/3581).2. Compare the lymph node metastatic ratio of all groups, the group of higher rates were NO.2、4、5、7、8M、8L、16、17、20,the group of lower rates were NO.1、3、6、9、10、15、18、19.3. The upper thoracic esophagus had 31 cases, the lymph node metastatic rate was35.48%, 321 lymph nodes were dissected, the lymph node metastatic ratio was13.40%. The groups of higher lymph node metastatic ratio in the upper thoracic esophageal sequamous cell carcinoma(ESCC) were 1、2、4、5、7、9,which were 16.67%、29.73%、24.00%、16.67%、16.21%、16.67%(>13.40%), respectively. The middle thoracic esophagus had 187 cases, the lymph node metastatic rate was47.06%, 1931 lymph nodes were dissected, the lymph node metastatic ratio was14.81%. The groups of higher lymph node metastatic ratio in the middle thoracic ESCC were2、4、5、7、8M, which were 16.67%、16.67%、22.22%、22.63%、21.07%(>14.81%), respectively. The lower thoracic esophagus had 101 cases, the lymph node metastatic ratiowas56.43%, 1329 lymph nodes were dissected, the lymph node metastatic ratio was 17.53%.The groups of higher lymph node metastatic ratio in the lower thoracic ESCC were4、5、7、8L、16、17、20, which were 17.86%、18.52%、17.74%、21.74%、24.42%、21.51%、21.74%(>17.53%), respectively.4. The cervical and upper mediastinal lymph node metastatic ratio was significantly higher in the upper thoracic ESCC than in the middle and lower thoracic ESCC(16.7%and 21.4%). The middle mediastinal lymph node metastatic ratio was significantly higher in the middle thoracic ESCC than in the upper and lower thoracic ESCC(19.7%).The celiac lymph node metastatic ratio in the lower thoracic ESCC(21.5%) was the highest in all.5. Univariate analysis revealed that lymph node metastasis was correlated with the tumor length, depth of invasion, pathological grade, and presence of vascular invasion,but uncorrelated with gender,age, disease site, incisal edge situation. Those with lower differentiation, large tumor length, deep invasion and vascular invasion had higher lymph node metastatic rate.6. With Multiple factors logistic regression analysis showed that tumor length,depth of tumor invasion were independent risk factors for lymph node metastasis.Conclusions:1. The groups of higher lymph node metastatic ratio in the upper thoracic esophageal sequamous cell carcinoma(ESCC) were 1、2、4、5、7, while in the middle thoracic ESCC were2、4、5、7、8M,in the lower thoracic ESCC were4、5、7、8L、16、17、20.2. Tumor length and depth of tumor invasion were independent risk factors for lymph node metastasis.3. Lymph node metastasis was correlated with tumor length, depth of invasion,pathological grade and presence of vessel invasion.Those with lower differentiation,large tumor length, deep invasion and vascular invasion had higher lymph node metastatic rate. During the target delineation of radiotherapy for esophageal carcinoma,we should consider the factors influencing lymph node metastasis comprehensively.