| Objective:To retrospectively analyze the occurrence of supraclavicular lymph node metastasis in patients with esophageal cancer,to explore the prognostic factors of esophageal cancer patients,and to discuss the TNM staging of the seventh edition of supraclavicular lymph node metastasis of esophageal cancer developed by AJCC and UICC in 2009.It provides a reference for the clinical staging of supraclavicular lymph node metastasis of esophageal cancer and provides a reference for the treatment of clinical supraclavicular lymph node metastasis.Materials and Methods:A total of 1259 patients from the Western Theater General Hospital(formerly Chengdu Military General Hospital)were collected from January 2011 to December2016.All patients underwent radical chemoradiotherapy with at least four cycles of chemotherapy.Complete case data were collected and 132 eligible patients were finally included.According to the presence or absence of supraclavicular lymph nodes,the experimental group was the experimental group and the control group.The experimental group was the supraclavicular lymph node positive group(SCN+),and the control group was the supraclavicular lymph node negative group(SCN-).Patients and their families were followed up at least once by reviewing the case and telephone follow-up.The follow-up date was December 31,2018.Statistical analysis was performed using SPSS 22.0 statistical software.Survival rate was calculated according to Kaplan-Meier method.Survival rate difference was compared by Log-rank test.Multi-factor prognosis analysis was obtained according to Cox proportional hazard model.P < 0.05 was used as the significance test level.RESULTS:As of December 31,2018,Of the 132 patients,28 survived and 104 died.The median tumor progression free survival time(PFS)was 16 months,and the median overall survival time(OS)was 24 months.The PFS of 1,2,3,4,and 5 years were62.1%,36.8%,25.9%,18.8%,and 15.7%,respectively.the OS of 1,2,3,4,and 5 years was 75.8%,46.3%,35.3%,22.9% and 21.6%,respectively..Of the 132 patients,47 were in the experimental group and 85 in the control group.The median PFS of the two groups was 13 months and 17 months respectively.the PFS of 1,2,3,4,and 5 years were 57.4%,26.5%,18.6%,11.6%,5.8% respectively and64.7%,37.6%,28.3% 22.8%,20.5%,P=0.135.The median OS of the two groups was23 months and 24 months,respectively.The 1,2,3,4,and 5 year survival rates were74.5%,44.7%,31.8%,17.4%,and 13.9%,respectively.75.3%,47.1%,37.3%,25.8%,and 20.6%,P=0.216.Further subgroup analysis of the experimental group showed that the 1,2,3,4,and 5 year survival rates of the simultaneous and isochronous groups were68.6%,31.4%,20.2%,13.5%,and 6.7%,respectively.82.0%,41.7%.33.3%,16.7%,none(P=0.645).Unilateral and bilateral 1,2,3,4,and 5 year survival rates were 75%,42.5%,26.2%,19.1%,and 15.3%,respectively.71.4%,28.6%,14.3%,none,none(P=0.546)).The 1,2,3,4,and 5 year survival rates of the supraclavicular lymph nodes were ?3cm and >3cm were 77.8%,52.8%,35.9%,25.1%,and 20.1% respectively and63.6%,18.2%,9.1%,0%,0%(P=0.022).Among the prognostic factors,univariate analysis showed smoking(P=0.030),alcohol consumption(P=0.037),tumor length(P=0.002),T stage(P=0.023),N stage(P=0.001),clinical staging(P=0.039)had a statistically significant difference in prognosis.There was no significant difference in the prognosis survival time between age(P=0.270),gender(P=0.771),presence or absence of medical disease(P=0.232),tumor location(P=0.409),and M stage(P=0.216).Multivariate analysis showed that lesion length and N stage were important prognostic factors(P<0.05),while whether smoking(P=0.962),drinking(P=0.502),Tumor T stage(P=0.454)and clinical stage(P=0.323)had no statistical significance(P?0.05).Conclusion:1.There are many cases of supraclavicular lymph node metastasis in patients with esophageal cancer.Radical chemoradiotherapy is the first choice for patients who can not undergo surgery or do not want surgery.2.Whether the patient has supraclavicular lymph node metastasis has no effect on the prognosis of patients Statistical differences;3.multivariate analysis showed that the length of tumor lesions and the number of metastatic lymph nodes are important factors in the prognosis of patients for the subclinical lymph node group subgroup analysis,patients with supraclavicular lymph node diameter ? 3cm have a better prognosis.4.The prognosis of patients with supraclavicular lymph node metastasis is similar to that of patients with non-clavicular lymph node metastasis.It is recommended to be classified as regional lymph nodes during staging,but further multicenter,large sample studies are needed. |
PDF Full Text Request