Study On The Characteristics Of Lymph Node Metastasis And Its Impact On Prognosis In Thoracic Esophageal Carcinoma

Objective: To explore the distribution of lymph node metastases and to analyze theclinicopathologic factors with thoracic esophageal carcinoma, To investigate therelated influence of lymph node metastases in thoracic esophageal carcinoma and theinfluence on patient survival after curative resection.Methods: Retrospective analyze the medical records of thoracic esophagealcarcinoma in our hospital from Jan.2005to Dec.2009.446patients were selected,376cases were eligible. The regularity of lymph node metastasis of thoracicesophageal cancer and clinicopathologic factors were stratified. The affecting factorsof lymph node metastasis of thoracic esophageal cancer and were stratified. Fourteenpossible factors influencing survival were studied.Results: The whole group of376cases, the lymph node metastatic rate was38.93%(146/376). a total of2881lymph nodes were dissected with an average of7.66lymph nodes in each case. the metastatic rate of lymph node was12.16%(345/2881).The metastases lymph node of upper-thoracic esophagus were mainly observed in the region of neck, next to the recurrent laryngeal nerve, paratracheal, paraesophagealtransfer(p<0.05), the metastatic lymph node of middle-third thoracic esophagus werebidirectional, and the lower-third thoracic esophagus mainly metastasized to theregion of lateralesophagus, lateral cardiac and gastric artery(p<0.05). Both the lymphnode metastatic ratio and rate of gastric artery in the lower-thoracic esophagus weresignificantly higher than those in the middle-third and upper-third thoracic esophagus(p=0.001). With multiple factors Logistic regression analysis showed that tumorlength, depth of tumor invasion, vascular tumor embolus have become the importantfactors for lymphatic metastasis(p＜0.01). The5-year survival rates of all patientswere34.08%.According to multivariate analysis, tumor location, depth of tumorinvasion, lymph node metastasis, degree of lymphatic metastasis, number ofmetastatic lymph nodes. no significant difference and number of lymph nodesmetastatic field were independent prognostic-factors（P＜0.05）.The5-year survivalrates of number of metastatic lymph nodes0,1and≥2were50.01%、20.08%、12.77%（P＜0.05）.Conclusions: Factors including Lesion length, depth of tumor invasion,tumor celldifferentiation and vascular invasion should be focus on in the selection of indicationsof postoperative prophylactic radiotherapy after radical surgery of thoracic esophagealcarcinoma. Lymph node metastasis of esophageal cancer after radical resection of thesurvival of the most important factor, different number of metastatic lymph nodesmore accurately reflects the prognosis of survival of the state.