| Background and Objective:Malignant neoplasms, termed cancer, are one of the most common causes ofdeath, which has become a major public health problem. Despite major improvementsin diagnosis, surgical techniques, health care, and adjuvant therapy in recent years, allaimed at decreasing cancer mortality, carcinomas greatly attribute to human death.Recurrence and metastasis are recognized as the most important obstacle to thetherapeutic effect of esophageal cancer, and most of the deaths resulted from bysecondary, metastatic malignant turnouts that are resistant to conventional therapies.Currently, studies on the rules of lymph node metastasis caused by malignant tumorhave attacted much attention in the clinical research. On the other hand, as for basicfield, a major focus in cancer research is to understand the early events which cancercells escape from the primary tumour, invade local tissue and disseminate through theblood or lymphatic systems to colonise on remote sites. Therefore, identification ofmolecular markers that could provide more effective early diagnosis of potentiallyaggressive tumours is very significant. Fascin is a globular actin-cross-linking proteinthat can promote the invasion and metastasis of the tumor cell by increasing the cellprotrusions, changing the cell-ECM adhesion and other ways such as the signal pathway et al. Many evidences have proved that Fascin is likely to be a potentialcandidate as a novel biomarker or therapeutic target in treatment of malignant tumor.Esophageal squamous cell carcinoma is one of the most mortal malignanciesand affect the people greatly in China with the highest mortality rate of the world.According to the standard by stages of esophageal carcinoma of the InternationalUnion Against Cancer (UICC, 2003), the lymph node metastasis rate combined withthe metastasis ratio were not be included. But recent data show that the two index areimportant fators influencing the prognosis of esophageal cancer. Hence, studies onthe characteristics of lymph node metastasis are of profound and important meaning,they might be used for the comprehensive treatments of esophageal carcinomar.Chaoshan city is the only coast area among six regions with high incidence rate ofesophageal carcinoma in China, having special geography environmeny and localcustom. Consedering the local living surroundings and habits, further exploments tothe rules of lymph node metastasis will help promote the improve the diagnosis andthe cures of this disease. Moreover, in our previous work, Our group found thatFascin was overexpressed in the tissue of ESCC, and the high expression of Fascinwas correlated with cell proliferative activity, lymph node metastasis and worseprognosis. So, on the gound of these results, the aim of the study is:1. To explore the rules of lymph node metastasis, helping to select optimaltreatment scheme, then increase survival rate and curative effect in the long run andimprove quality of living.2. To detect the reletively plasmic Fascin level of pre-operation, post-operationpatients and normal people in thoracic esophageal carcinoma, so as to evaluat thevalue of Fascin as a novel biomarker for identification of the tumor at early stage.Materials and Methods:1. From Sep.2004 to Dec.2005, finish collecting full clinical materials andpostoperative specimens and select 156 cases of thoracic esophageal carcinoma as per choice standard, Icluding 127 cases of male and 19 cases of female.2. The experimental plasma came from 71 male and 19 female cases. Thecontrol plasma from the normal people who took the common medical examination inthe first affiiated hospital of SUMC includes 73 male and 17 female. All controlpeople were in nomal state with normal blood test, normal liver and renal fuction. Theblood samples of preoperation and normal people were obtained before eating anyfood in the morning, while the postoperation sample were obtained in 3±1 days afteroperation. All blood samples were confirmed to be no haemolysis, using EDTA foranticoagulation.3. Using ELISA, detect the plasmic level of Fascin expression of preoperationand normal control samples (90 cases), and detect the plasmic Fascin expressionpostoperation samples as well.4. Following up the data of the 156 cases such as the general state,characteristic of history, pathology results and the operation message. Establishing theclinical database of esophageal carcioma.Results:1. The lymph node metastasis rate of thoracic esophageal carcinoma was 51.92%(91/156) and the lymph node metastasis ratio was 12.4% (299/2410).2. Through analysis of influencing factor on rate of lymph node metastasis derivedfrom carcinoma of thoracic esophagus, the results showed that differentiation ofcancer cells (P=0.04), pathology stages (P＜0.001), depth of tumor invasion (P=0.04), position of lymph node metastasis (P=0.041) affect lymph nodemetastasis rate significantly, while length of tumor, gender, age, position ofesophageal carcinoma, and configuration of the carcinoma are not related withlymph node metastasis rate.3. Analysing ratio of lymph node metastasis under differernt factors, we found that length of tumor (P＜0.001), position of esophageal carcinoma (P＜0.001),differentiation of cancer cells (P＜0.001), pathology stages (P＜0.001), depth oftumor invasion (P＜0.001), configuration of the carcinoma and position of lymphnode metastasis (P=0.041) could influence the ratio of lymph node metastasis.4. Abdominal lymph node metastasis rate of thoracic esophageal carcinoma was30.13 %, metastasis ratio was 12.41%. Differentiation of cancer cells (P=0.047),position of esophageal carcinoma (P=0.0036), depth of tumor invasion (P=0.034) are correlated with rate of lymph node metastasis, with significantdifference in statistics.5. Four characteristics of lymph node metastasis were indicated in the study derivedfrom carcinoma of thoracic esophagus: "Jumping", Bidirectional (up and down),continuous and regional. Among those, the "Jumping" abdominal lymph nodemetastasi ratio of was 12.18% and the neck lymph node metastasi ratio was6.41%. Bidirectional lymph node metastasi ratio was 2.56%(4/156), Continuouslymph node metastasi ratio was 13.7% (23/156), regional lymph node ratio 33.3%(52/156).6. In the middle and inferior thoracic esophageal carcinoma, different regionallymph node had different metastasis rate (P=0.000).7. There was no difference in the plasmic level of Fascin expression between theESCC and normal control (P＞0.05). While the Fascin expression was higher inthose patients whose body weight was decreasing (P=0.034). Moreover,comparing the patients whose depth of tumor are longer than 8cm, the level ofplamic Fascin after operation was higher than those before operation (P=0.044). Conelusion:1. Carcinoma of thoracic esophagus has our characteristics of lymph nodemetastasis, that is "Jumping", Bidirectional (up and down), continuous andterritorial. Differentiation of cancer cells, pathology staging, depth of tumor invasion, position of lymph node metastasis affect rate of lymph node metastasis.Meanwhile, length of tumor, position of esophageal carcinoma, differentiation ofcancer cells, pathology staging, depth of tumor invasion, configuration of thecarcinoma and position of lymph node metastasis are correlated to lymph nodemetastasis ratio.2. The "jumping" lymph node ratio remain high in thoracic esophagealcarcinoma, which indicates that it is necessary to the clear up the abdominal andneck lymph node during operation.3. The abdominal lymph node metastasis rate in middle and inferior ESCC is higherthan that in the thoracic cavity, suggesting that it is also necessary to enlarge therange of clearing up the abdominal lymph node.4. Fascin is likely to be a novel potential biomarker, enabling the ESCC to beidentified at early stage in high-risk individuals, while the detection of theplasmic Fascin expression requires the further evaluation.
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