| Background and objective:Esophageal cancer is one of the most common malignant tumors of the digestive tract.The incidence of this cancer in our country is the sixth in the malignant tumor,and about 200 thousand people die from esophageal cancer every year.With the development of digestive endoscopy in China,the detection rate of early esophageal cancer has been improved obviously,and the application and development of endoscopic treatment techniques such as endoscopic mucosal resection(EMR)and endoscopic submucosal dissection(ESD)have also been promoted.Superficial esophageal carcinoma(SEC)refers to the lesion that is confined to the mucosal layer or submucosa with or without lymph node metastasis,included Stage T1 a and T1 b esophageal carcinoma.If superficial esophageal carcinoma does not have lymph node metastasis,EMR?ESD and other endoscopic minimally invasive treatment can be used to achieve similar results as surgical treatment,to avoid the severe trauma and complications caused by surgical treatment and improve the quality of life after operation.If lymph node metastasis occurs,it should be treated according to progressing esophageal cancer.However,in practice,it is still difficult for clinicians to judge whether superficial esophageal cancer has lymph node metastasis.By retrospective analysis of 325 cases of superficial esophageal carcinoma,the diagnostic value of thin-layer enhanced CT in lymph node metastasis and the law of lymph node metastasis of superficial esophageal carcinoma was discussed,and the influence of age,sex,tumor location,lesion length,depth of invasion and pathological type on lymph node metastasis of superficial esophageal carcinoma were analyzed to provide a reference for clinical treatment of superficial esophageal carcinoma.Materials and methods:We reviewed the postoperative pathological reports of superficial esophageal cancer patients who underwent thin-layer enhanced CT and thoracic surgery in our hospital from June 2012 to June 2017.325 cases of superficial esophageal carcinoma with Stage T1 a and T1 b were selected.Compared with the pathological results,the information including the short-axis diameter,length-axis diameter,aspect ratio,average CT value of lymph node and average CT value of muscle in the same slice of the corresponding lymph nodes on thin-layer enhanced CT was observed by two physicians.After the agreement was reached,the data were recorded and analyzed by SPSS 22.0 software.The sensitivity,specificity,Youden index and area under the curve were calculated by ROC curve for the diagnosis of lymph node metastasis of superficial esophageal carcinoma.From sex,age,tumor location,length of lesion,depth of invasion,degree of differentiation,pathological type and so on,the characteristics and regularity of lymph node metastasis in superficial esophageal carcinoma were summarized to analyze the relationship between the observation indexes and lymph node metastasis after operation in patients with superficial esophageal carcinoma.The comparison between the sample rates of each group was conducted with the method of the chi-square test and Fisher's exact probability method.P<0.05 was considered statistically significant.Results:1.The diagnostic criteria for lymph node metastasis of superficial esophageal carcinoma with the short-axis diameter ? 5.79 mm,length-axis diameter? 7.38 mm,aspect ratio ? 1.56 and the degree of enhancement ? 1.185 of the lymph nodes of thin-layer enhanced CT,the sensitivity was 0.758,0.661,0.580 and 0.629,respectively;the specificity was 0.773,0.705,0.774 and 0.716,respectively;the Youden index was 0.531,0.366,0.354 and 0.345,respectively;the area under the curve is 0.826,0.709,0.738 and 0.700,respectively.2.The area under the ROC curve is the largest and the diagnostic value is the highest when the maximum short-axis diameter ? 5.79 mm is used as the diagnostic criterion for superficial esophageal carcinoma lymph node metastasis.3.The lymph node metastasis rate of superficial esophageal carcinoma in the whole group was 14.46% and the lymph node metastasis degree was 2.05%.The highest lymph node metastasis rate was the right recurrent laryngeal nerve lymph node,the left side recurrent laryngeal nerve lymph node and the nodes of esophagus,with the metastasis rate 11.03%?10.71%?8.62%,respectively.The lymph node with the highest metastasis degree was the right recurrent laryngeal nerve lymph node,the lymph nodes of the left recurrent nerve and the lymph nodes of esophagus,with the metastasis degree 5.47 %,2.81% and 2.43%,respectively.4.age < 60 years and over 60 years of superficial esophageal cancer lymph node metastasis rate were 9.27% and 18.97%,which has significant difference(P=0.013).The length of lesions less than 2cm and more than 2cm of superficial esophageal cancer lymph node metastasis rate were 10.61% and 20.47%,there was statistical significance(P=0.014).The depth of invasion of M2,M3 and SM of superficial esophageal cancer lymph node metastasis rate were 1.49%,8.57% and 21.28%,the difference was statistically significant(P=0.000).High degree differentiation,median degree differentiation and low degree differentiation of superficial esophageal carcinoma lymph node metastasis rate were 5.48%,12.82% and 31.79%,the difference was statistically significant(P=0.020).The pathological types of squamous cell carcinoma and non-squamous cell carcinoma of superficial esophageal cancer lymph node metastasis rate were 13.61% and 44.44%,there were significant differences(P=0.035).5.By multivariate Logistic regression analysis,it was suggested that the length of lesion(P=0.016),and the depth of infiltration(P=0.048),degree of differentiation(P=0.000)and pathological type(P=0.027)were the risk factors of lymph node metastasis of superficial esophageal carcinoma.However,age,sex and tumor location had no significant effect on lymph node metastasis of superficial esophageal carcinoma.Conclusions:1.Thin-slice enhanced CT can provide a certain reference value for lymph node metastasis of superficial esophageal carcinoma when the maximum short diameter ? 5.79 mm,the maximum length ? 7.38 mm,the aspect ratio ? 1.56 or the enhancement degree ? 1.185.The maximum short-axis diameter of lymph nodes on thin-layer enhanced CT can be used as the best diagnostic method for lymph node metastasis of superficial esophageal carcinoma,and the best short diameter is 5.79 mm.2.The most likely sites of lymph node metastasis in superficial esophageal carcinoma were right recurrent laryngeal nerve lymph node,left recurrent laryngeal nerve lymph node and paraesophageal lymph node.The right recurrent laryngeal nerve lymph node metastasis rate and the degree of metastasis are the highest.In view of this,the right thoracic approach of esophageal cancer surgery is recommended,because the left thoracic approach of esophageal cancer radical surgery cannot systematically dissection the thoracic region of lymph nodes,especially the lymph nodes in the right superior mediastinal region and the right recurrent laryngeal lymph nodes.3.Binary multivariate Logistic regression analysis showed that the length of lesion,depth of invasion and pathological type were independent risk factors for lymph node metastasis of superficial esophageal carcinoma.The length of lesion is more than 2 cm,the depth of infiltration is greater,poor differentiation and pathological type of non-squamous cell carcinoma are more likely to develop lymph node metastasis.Therefore,for these suitably qualified superficial esophageal cancer patients,even if the adjuvant examination cannot be sure whether there is lymph node metastasis,it still needs active attention.It is best to refer to the treatment of invasive esophageal cancer. |
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