1、The Clinical Characteristics Of Multiple Primary Cancer Associated With Esophageal Squamous Carcinoma 2、The Research Of Endoscopic Ultrosonography (EUS)in N Stage Diagnosis Of Esophageal SquamousCarcinoma

Part Ⅰ The clinical characteristics of multiple primary cancer associated with esophageal squamous carcinoma.M.D. Sudent:Shun He Supervisor:Gui-qi Wang Department of Endoscopy, Cancer Institute and Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, P.R. China【Objective】This study was performed to examine the characteristics of esophageal squamous cancers with multiple primary cancers in another organ.Methods【Patients and Methods】Between 2012January and 2014December,3104 patients withesophageal squamous cell carcinoma treated inCancer Institute and Hospital, Chinese Academy of MedicalSciences, were reviewed for the presence of an additional primary cancer retrospectively. The patients were divided into two groups according to whether they had multiple primary cancer.【Results】Totally 369 (11.9%) patients were found multiple primary cancer in the other organs. Among these patients,72.4% was found synchronously, another primary cancer was found in the head and neck region in 211(6.8%), in the stomach in 140 (4.2%), and in the lung, colon,breast,and other locations in the remaining patients. Of the 211patients with another primary cancer in the head andneck region,156 (73.2%) had hypopharyngeal cancer. Furthermore, the incidence of intraesophageal multiplecancerous lesion in the patients with primary cancer in the headand neck region was significantly higher than that inthosewhose other primary cancers were gastric canceror in those with non-multiple primary cancer (P< 0.0001).【Conclusions】There is a high incidence of multipleprimary cancers in patients with esophageal squamous carcinoma, mostly found synchronously. The leading multiple primary cancers were head and neck cancer and stomach cancer. Intraesophageal multiplecancerous lesion is an indicator for a second primary cancer in head and neck. Abetter knowledge ofthe relationships between esophageal carcinoma andcancers in other organs may lead to earlier detectionof other primary cancers and improved therapeuticresults.Part Ⅱ The research of endoscopic ultrosonography (EUS) in N stage diagnosis of esophageal squamous carcinoma【Objective】Endoscopic ultrasonography (EUS) have been shown to be the one of the most useful diagnostic tools to evaluate if a lymph node is benign or malignant in nature, which play a vital role in the N diagnosis of esophageal squamous carcinoma. In this study, we aimed to evaluate the EUS characters of lymph nodes in predicting malignant one or not.【Patients and Methods】One hundred and twenty-three patients who underwent Radical resection of esophageal cancer in our center from January 2014 to June 2004 were enrolled in the study. Before the resection, all the patients received the EUS examination. The images were reviewed retrospectively, and 9 character were recorded, including long diameter, short diameter, short diameter/long diameter, hypoechoic pattern, round shape, smooth border, number of lymph nodes identified on EUS exam, T3/4 stage tumor based on EUS exam and lymph node location. According to the pathological N diagnosis results post-surgery, the relationship between the EUS lymph node characters and malignant lymph node were analyzed for the most valuable EUS lymph node criteria may predict which lymph nodes are benign or malignant in nature.【Results】Among the lymph node detected by EUS,82.4% can be found in the surgical specimen. The character of long diameter, short diameter, short diameter/long diameter and number of lymph nodes were analyzed by ROC curve, the best cutoff value is> 7.5mm,> 5.5mm and>2, respectively. There are 8 characters shows a good performance in distinguish the malignant and benign lymph node. Modified standard (7 characters) for lymph-node staging were more accurate than routine standard (4 characters), area under the curve 0.88 vs.0.78, respectively. Short diameter>5.5mm, round shape, lymph node aside the tumor and hypoechoic pattern were separate criteria in diagnosis malignant lymph node. The accuracy of modified standard (7 characters) in N stage diagnosis of esophageal squamous cancer also is better than that of routine standard (4 characters), 74.1% vs.58%.[Conclusions]Modified standard for lymph-node staging were more accurate than Routine standard. Characters combination can improve the diagnosis of lymph node metastasis of esophageal squamous cancer.