| Objectives: To assess the value in diagnosing lymph node metastasis of esophageal carcinoma by preoperative CT scanning. At the same time, to evaluate prognostic effect of different number of metastatic lymph nodes and metastatic regions in preoperative CT scanning and postoperative pathological results. At last, to analyze the prognostic factors of esophageal carcinoma.Methods: Retrospective analysis of 278 cases of esophageal carcinoma after radical resection at the Fourth Hospital of Hebei Medical University from June 2002 to June 2006, all patients did not receive preoperative and postoperative chemoradiotherapy, and complete information of postoperative pathological reports. All patients were examinated by CT scanning at our hospital one week before the surgery. According to esophageal conventional CT scanning, the slice thickness and the layer distance were 3.0-6.0mm, the CT scanning followed layer by layer from the lower neck to superior abdomen level, and some cases used of enhanced scanning. The CT scanning image were transmitted to the Philips TPS Pinnacle 7.6c American three-dimensional treatment planning system by the network at digital format and be reconstructed, in this system we observed, measured and recorded every index, including the tumor location and length of esophageal carcinoma, the diameter of largest dimension of tumor, the greatest depth of invasion, the regions and the numbers of lymph node metastasis. Intrathoracic lymph node regions were divided by accordance with American Thoracic Society standards of intrathoracic lymph node distribution, including the lower neck, chest and upper abdominal lymph nodes region and combined with lymph node dissection criterion of clinical operations of our hospital. Then we compared with postoperative pathological results. All database was set up by Statistical Package of SPSS11.5, the survival rate was calculated by Kaplan-Meier method, and the significance test by Log-rank method. The rate of every group was analyzed by usingχ2 or Fisher exact test, and the correlationship of every variable were evaluated by Spearman correlation analysis.Results:⑴13 cases were out of contact among these 278 cases, so the follow-up rate was 95.32%. The 1-, 3-, 5-years survival rates were 76.79%, 48.83%, 35.91% respectively since the surgical resection date. The average survival time and median survival time were 44.05 months and 34.17 months respectively. Lymph node metastases were found in 101 of those 278 esophageal cancer patients (36.33%).In those 2232 lymph nodes dissected, metastases were found in 250 (11.20%).⑵In all patients, the sensitivity, specificity, positive predictive value, negative predictive value, Younden index and accuracy rates of diagnosis of lymph node metastasis with preoperative CT scanning were 59.00%,68.50%,51.30%,74.80%,27.50%,65.10% respectively. The accuracy rate of diagnosis lymph node metastasis by preoperative CT scanning in upper-thoracic case up to 90.60%, followed the middle-thoracic case(88.80%), and the lowest accuracy rate was in lower-thoracic cas(e80.90%). While in the three regions method, the accuracy rate of diagnosis lymph node metastasis on inferior upper-abdomen by preoperative CT scanning showing was higher than mediastinum and lower neck(81.30%,75.20%,72.70%).⑶The regional recurrence and distant metastases rates of the postoperative patients with 0,1-2and≥3 positive nodes were 36.31%,66.15%,77.42% and 6.55%,18.46%,19.35% respectively. There was a statistical significance among three groups. In the three regions method,the regional recurrence and distant metastases rates of postoperative positive metastatic regions with 0, 1and≥2 were 36.31%,63.49% ,81.82% and 6.55%(11/168),20.63%(13/63),15.15%(5/33)respectively. The difference was significant. The 1- year,3- year and 5- year survival rates of the postoperative patients with 0, 1-2and≥3 positive nodes were 84.75%,62.05%,53.68%,70.59%,33.82%,10.52% and 48.48%,9.09%,3.03%,respectively. There was a statistical significance among three groups and every group. The 1- year,3- year and 5- year survival rates of the postoperative patients with 0, 1and≥2 metastatic regions were 84.75%,62.05%,53.68%,65.67%,28.36%,9.64% and 58.82%,20.59%,5.88%,respectively. The difference was significant.⑷With the numbers of positive nodes increasing(0, 1-2and≥3 positive nodes),the regional recurrence rate increased gradually of patients with preoperative CT scanning. The difference was significant. But there was no statistical significance in diagnosising regional recurrence rate with preoperative CT scanning in different metastatic regions (0,1and≥2 ).Also, there was no statistical significance in diagnosising distant metastases rate with preoperative CT scanning in different positive nodes and metastatic regions. With preoperative CT scanning, the survival rates of the patients with 0, 1-2,≥3 positive nodes were descend gradually. There was a statistical significance among three groups and every group. The survival rates of the patients with 0, 1,≥2 metastatic regions were descend gradually. There was a statistical significance among three groups. But there was no statistical significance between latter groups(1and≥2 metastatic regions).⑸So far,167 patients were died, due to operations 14(8.38%),regional recurrence 122(73.05%),distant metastases 28(16.77%),chronic disease 3(1.79%),respectively. The 1- year,3- year and 5- year survival rates of the patients with regional recurrence and distant metastases were lower than the patients with non-recurrent and non-metastases. There was a statistical significance between two groups. For the patients with 0, 1-2 positive nodes and 0, 1metastatic region, the 1- year,3- year and 5- year survival rates with regional recurrence were lower than the patients with non-recurrent. There was a statistical significance between two groups. But there was no statistical significance with≥3 positive nodes and≥2metastatic regions about regional recurrence and non-recurrent. For the patients with no positive nodes and metastatic regions, the 1- year,3- year and 5- year survival rates with distant metastases were lower than the patients with non-metastases. There was a statistical significance between two groups. But there was no statistical significance with 1-2 and≥3 positive nodes ,1and≥2metastatic regions about distant metastases and non-metastases.Conclusions: (1)The value of preoperative CT scanning was importance in diagnosising lymph node metastasis of esophageal carcinoma ,but the sensitivity, specificity, and accuracy shoud be enhanced. (2) The three grade classification (0, 1-2,≥3 positive nodes) can well reflect the relationship between the numbers of lymph node metastasis and the patient survival. (3) With the number of positive nodes and metastatic regions increasing, the regional recurrence rates and distant metastases rates increased obviously, and survival rates descend remarkably. Especially the patients with three or more lymph nodes and two or more metastatic regions might be given assistant therapy to improve prognosis .
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