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1、Pattern of lymph node metastasis in patients with squamous cell carcinoma of the thoracic esophagusHecheng Li, MD subcarinal; mediastinal; perigastricnSurgical resection is the standard treatment for early esophageal cancerRole of 3-F lymph node dissectionnThree field dissection for esophageal cance
2、r has been practiced since the early 1980s Advantages: Best way for lymph node dissection Decrease local recurrence Accurate information for staging Offer patients survival benefit Disadvantages: Morbidity and mortality were increased Negative reports with regard to survival benefitObjectivesnTo stu
3、dy the pattern of lymph node metastasis in patients Analyze the relationship between tumor location and LN metastatic sites Find factors predicting LN statusnWe aim to perform 3-FLD individually for patients so that morbidity and mortality could be decreasedPatients InformationnPatients recruited be
4、tween Jan. 2001 and Jan. 2005nAll patients from Cancer Hospital of Fudan UniversitynIncluded criteria: With pathologically confirmed squamous carcinoma Medically fit for thoracic surgery Resetectable disease(T1-3 and resectable T4) No distant metastasisnSurgical treatment: 3-FLDnExcluded criteria: p
5、reoperative chemotherapy and/or radiotherapyn230 patients were included in the current analysisFactorsDataAge(years)55.67.9 Gender(male:female)183:47 pTpT1pT2pT3pT417 95 116 2Location of tumorUpperMiddleLower36 150 44Tumor length3cm37cm7cm35 150 45 angiolymphatic invasionyesno21 209 Tumor grade(diff
6、erentiation)WellModPoor58 148 24 StageIIIIIIVIa35 114 40 41Demographic and clinicopathological data of patients Lymph node grouping Cervical nodes: No.104 and Nos.101; Thoracic nodes: 106rec, Nos. 105, 108, and 110, Nos. 107, 109, and 106tb,Nos. 111 and 112; Abdominal nodes: Nos. 1, 2, 3, 7, 8.Stati
7、stical analysisnChi-square: The metastatic sites of lymph nodes were correlated with tumor locationnLogistic regression: The relationship between clinical and pathological factors and lymph node metastasisnSPSS 11.0 software program (SPSS Inc., Chicago, USA).ResultsRates of node metastasis in differ
8、ent locationTumor locationRates (%)(No. of cases with lymph node metastasis/total) Cervical thoracic abdominal upper41.6(15/36)19.4(7/36)8.3(3/36)middle33.3(50/150)34.7(52/150)14(21/150)lower36.4(16/44)34.1(15/44)43.2(19/44)Rates of node metastasisRates of node metastasis 57.8%(133/230).Rates of nod
9、e metastasis 57.8%(133/230).Rates of node metastasis in different locationTumor locationRates (%)(No. of cases with lymph node metastasis/total) Cervical thoracic abdominal upper41.6(15/36)19.4(7/36)8.3(3/36)middle33.3(50/150)34.7(52/150)14(21/150)lower36.4(16/44)34.1(15/44)43.2(19/44)Notice: NA, no
10、t applicable. Risk estimate statistics cant be computed. They are only copmputed for 2*2 table without empty cells.Comparison cervical metastatic rate among upper, middle and lower esophageal cancerTumor locationRelative risk(95%CI)2 P valueUpper*middle*lowerNA0.9150.633Upper* lower0.800(0.3241.975)
11、0.2350.628Middle*upper0.700(0.3321.474)0.8870.346Lower * middle 1.143(0.5672.306)0.1390.709Rates of thoracic node metastasis in different locationsTumor locationRates (%)(No. of cases with lymph node metastasis/total) Cervical thoracic abdominal upper41.6(15/36)19.4(7/36)8.3(3/36)middle33.3(50/150)3
12、4.7(52/150)14(21/150)lower36.4(16/44)34.1(15/44)43.2(19/44)Comparison of rates of lymph node metastasis at thoracic cavity among pts with different tumor locationNotice: NA, not applicable. Risk estimate statistics cant be computed. They are only copmputed for 2*2 table without empty cells.Tumor loc
13、ationRelative risk(95%CI)2P valueUpper*middle*lowerNA3.1740.205Upper* lower2.143(0.7626.028)2.1300.144Middle*upper2.198 (0.902 5.360)3.1060.078Lower * middle 0.975(0.4801.979)0.0050.944Rates of node metastasis in different locationTumor locationRates (%)(No. of cases with lymph node metastasis/total
14、) Cervical thoracic abdominal upper41.6(15/36)19.4(7/36)8.3(3/36)middle33.3(50/150)34.7(52/150)14(21/150)lower36.4(16/44)34.1(15/44)43.2(19/44)Comparison of abdominal metastatic rate among upper, middle and lower esophageal cancerTumor locationRelative risk(95%CI)X2P valueUpper*middle*lowerNA22.0750
15、.001Lower *upper8.360(2.22531.418 )12.0600.001Middle*upper1.791(0.5046.368)0.830 0.362Lower * middle 4.669(2.19969.923 )17.7010.001Notice: NA, not applicable. Risk estimate statistics cant be computed. They are only copmputed for 2*2 table without empty cells.Factors affecting lymph node metastasisFactorsRegression coefficientStandard errorWaldP valueRelative hazardAngiolympha tic invasion-1.9890.7616.833.0090.137Depth of invasion(T1, 2*T3,4)-.7260.2786.8280090.484ConclusionsnThe esophageal carcinoma is more likely to spread craniall
