| 1Background and PurposeEsophageal cancer is one of the six most common malignancies in the worldwide, and in our country was ranked fourth in the cause of death. The vast majority of patients with typical diagnosis is already advanced stage, very difficult to detect to the early symptoms of esophageal cancer, and5-year survival in advanced esophageal cancer is still less than10%. The diagnosis of esophageal cancer is mainly depending on the technology of gastroscopy and biopsy, but most of the individuals cannot tolerate the pain of endoscopy, so gastroscopy is limited in a certain extent on the census of application. With the lack of the targeted therapy approach, the efficacy of chemotherapy in the treatment of esophageal cancer is poor, even ineffective, resulted that the clinical main treatment of esophageal cancer in our country is still surgical therapy. At present, to the surgical treatment of esophageal cancer, lymph node dissection and number of clinical surgeon still is the main problem of the surgeon continually. To judge the situation of the lymph node metastasis in the preoperative or intraoperative, a large sample survey data is still on the low. Lymph node metastasis is known as one of the significant prognostic factor for the patients with esophageal cancer, and the survival of the metastasis-positive patients was significantly worse than the transfer of negative ones. While the relationship of characteristics and influencing factors to lymph node metastasis and the survival in the high and low-incidence area is unclear. By epidemiology and survival follow-up in the high and low incidence area of esophageal cancer in Henan Province, this study analyzes of the lymph node metastasis related factors in high and low incidence area and their impact on survival of patients with esophageal cancer, and prognostic impact and standard on the new TNM staging of esophageal cancer will be the number of lymph node metastases to evaluate as evaluation criteria, deepen understanding of key prognostic factors of the esophageal cancer.2Materials and Methods2.1Patients14,132cases have a clear record pathological diagnosis and lymph node metastasis in patients with esophageal cancer (90%of the patients were fasted venous blood sample), the diagnosis time during1973-2011years, which were8995cases of high incidence, low incidence area5,137cases, high and low incidence areas the proportion of patients1.8:12.2Questionnaires and review of clinical data supplementFace to face questionnaire forms is used in this study, collecting Henan high and low incidence areas of esophageal cancer in patients with epidemiological data, and esophageal cancer patients or their families was investigated.This survey is a retrospective survey, because of the patients and their families cannot truthfully answer the clinical pathological information, the research visited hospitals as a way of classifying the group of patients, and according to the investigations unit of esophageal cancer patients in the hospital group, admission to verify additional clinical pathological information.2.3Standards2.3.1Positive lymph node metastasisIt is at least one Positive lymph node metastasis in esophageal cancer, that lymph node metastasis is judged as positive2.3.2TNM stagingThis study is a retrospective survey, and the majority of patients treated at the sixth edition staging criteria, in this study following the sixth edition of the TNM staging of esophageal cancer.2.3.3high-and low-incidence areaIt is adjusted for age and mortality, based on Chinese esophageal cancer’s Epidemiological findings, noted the high incidence areas for mortality at50/10million or more. Zoning refers to the book of "esophageal cancer".2.4Follow-upWith the interview of home or telephone survey, it is carried out as the main way of esophageal cancer survival follow-up. Last follow-up time was in March2013. With successfully followed13,605cases, the success rate was96%. Successful follow-up of patients with no esophageal cancer death of39patients, of whom three died of intestinal obstruction, seven people died in the accident,20people died of cardiovascular and cerebrovascular diseases, even nine people died by suicide.2.5StatisticsUsing SPSS18.0, for data processing, high and low incidence area of esophageal cancer patients with different gender, age and pathological features of lymph node metastasis rate and N classification differences using chi-square test; two Yuan Logistic regression analysis screening factors affecting lymph node metastasis; survival time based on an annual, Kaplan-Meier method and the Log-rank analysis of univariate survival under conditions of patients, Cox proportional hazards model screening independent factors affecting survival, test level:α<0.05. 3Results8672cases (63.9%) in the high-incidence area (HIA) and4,894cases in the low-incidence area (LIA), successful followed13,605cases (96%). The survival time in LNM negative patients (n=7945) was significantly longer than in LNM positive patients (n=5621)(P=1.9E-162).The survival time was successively reduced in N1, N2and N3patients with EC (P=4.2E-20). It was noteworthy that, the positive rate of LNM in HIA patients was higher than in LIA patients (P=1.4E-5), however the survival time in HIA patients was significantly longer than in LIA patients (P=1.7E-39). Furthermore, the positive rate of LNM in younger patients,(≤50years) was slightly higher than in elderly patients (>50years)(P=0.003), the survival time in younger patients (≤50years) was significantly longer than in elderly patients (>50years)(P＝2.3E-31). The positive rate of LNM in male patients was higher than in female patients (P=2.7E-11), the survival time in male patients was significantly lower than in female patients (P=2.6E-22). The positive rate of LNM in lower segment EC patients was significantly higher than the middle and upper segment EC patients (P=8.6E-24), and the survival time was significantly longer than the middle and upper segment EC patients (P=0.03). The positive rate of lymph nodes metastasis was significantly higher as the grade of differentiation lowing and the depth of invasion deepening (P differentiation=2.9E-20, P invasion=1.4E-186), and survival time was significantly decreased (P differentiation=6.1E-41, P invasion=1.8E-109). Multivariate regression analysis showed that, the HIA and LIA, gender, age at diagnosis, tumor location, differentiation, and invasion were independent factors for LNM and survival of patients with EC. The risk of poor survival values was successively increased in N1, N2and N3patients with EC (HRN1=1.8, HRN2=2.6, HRN3=2.7) 4ConclusionsThe study found that the number of lymph node metastasis and metastasis affecting survival of patients with esophageal cancer were independent prognostic factors, gender, age, height, low-incidence areas, tumor location, tumor differentiation, tumor size and depth of invasion is affected lymph node metastasis and survival independent factors, and further deepen the regional lymph node metastasis. The analysis of positive lymph node dissection site and the total number, with specification and quantity of parts lymph node dissection, is significantly important for improving survival of patients with esophageal cancer. |
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