The Influencing Factors And Prognostic Significance Of General Para-hepatic Artery Lymph Node Metastasis In Esophageal Carcinoma

Objective:To understand the risk factors and prognostic value of para-hepatic lymph node metastasis in esophageal cancer,and to provide a theoretical basis for the strategy of para-hepatic lymph node dissection in esophageal cancer.Methods:A retrospective analysis was performed on 220 patients who underwent radical resection of esophageal carcinoma with total para-hepatic artery lymph node dissection and had complete follow-up data from January 2013 to January 2020 in the department of thoracic surgery,affiliated hospital of north Sichuan medical college(the same treatment group).Risk factors of para-hepatic lymph node metastasis were analyzed by single factor and logistic regression.Single factor and Cox proportional regression risk model were used to analyze the value of para-hepatic lymph node metastasis in the prognosis of esophageal carcinoma.On this basis,nomogram model was constructed to evaluate the correlation between the risk of para-hepatic lymph node metastasis and the prognosis of patients with esophageal cancer.Calibration curve and c-index were used to evaluate the accuracy of the model.Result:Single-factor analysis showed that tumor location(P=0.022),degree of differentiation(P<0.001),tissue type(P=0.005),tumor invasion depth(T stage)(P<0.001),and N stage(P<0.001)were the risk factors for metastasis to the common hepatic artery lymph nodes of esophageal cancer.Logistic regression analysis showed that tumor invasion depth,N stage and differentiation degree were the independent risk factors for common hepatic artery lymph node metastasis of esophageal carcinoma.Single factor analysis showed that tumor infiltration depth(T staging)(P<0.001),and N staging(P<0.001),the degree of differentiation(P<0.001),histological types(P=0.018),common hepatic artery lymph node metastasis(P=0.042)for esophageal cancer prognosis factors of Cox regression analysis showed that tumor infiltration depth installments(T)(P<0.001),N staging(P=0.045),common hepatic artery lymph node metastasis(P=0.023)for esophageal cancer prognosis independent factors.Were independent risk factors of the Logistics regression results,the main prognostic factors in the COX regression analysis result as predictors Nomogram model rendering,graphical calibration prediction of curve in line with the standard calibration curve fit is good,the common hepatic artery can be thought of lymph node metastasis by risk factors predicted and observed values conform to the degree of good,the prognosis of esophageal cancer predicted and observed values conform to the degree of good.Conclusion:1.The depth of tumor invasion,N stage and degree of differentiation were independent risk factors for the metastasis of the para-hepatic lymph nodes of esophageal carcinoma;2.The depth of tumor invasion,N stage and para-hepatic lymph node metastasis were independent prognostic factors for patients with esophageal cancer.3.The Nomogram model can effectively assess the risk of para-hepatic lymph node metastasis of esophageal cancer and predict the postoperative survival rate of patients with esophageal cancer,providing strong support for the selection of clinical research and treatment plans;4.When preoperative examination indicated that tumor infiltration depth?T3 or tumor differentiation degree=G3,routine intraoperative dissection of para-hepatic lymph nodes was recommended;Preoperative multiple lymph node metastasis was suggested,or perigastric lymph node involvement was found,routine intraoperative dissection of para-hepatic lymph nodes was recommended.When tumor invasion depth<T3 and differentiation degree<G3,relevant risk factor scores obtained by Nomogram model can be summed to find the corresponding metastasis risk on the Nomogram,and comprehensively evaluate whether the patients are routinely dissected intraoperatively for the para-hepatic lymph nodes.