The Related Factors Analysis Of The Subcarinal Lymph Node Metastasis In The Middle And Lower Segment Of The Thoracic Esophageal Squamous Carcinoma

Objective:Realizing the metastatic case of the subcarinal lymph node in the middle and lower segment of the Thoracic esophageal carcinoma.Analyzing its metastatic status and the relationship between the clinical,imaging and pathological factors,the impact on the related factors and prognosis of surgery.Providing certain basis for patients with esophageal cancer who are established individual operation scheme. Methods:Selecting87cases of esophageal cancer patients admitted by Xin Jiang medical university affiliated tumor hospital in2012-2014.Analysising the relationship between the status and tumor location, focal length, infiltrating depth differentiation degree, the characteristics of lymph nodes on the imaging examination of CT, validating the result of the retrospective study.Results:In all87cases of the group,there are15cases which cleaned subcarinal lymph node,and there are clean72cases be not cleaned it.Cleaning the group overall,subcarinal lymph node shift rate is17.24%(15/87),transfer degree is6.57%(22/335).In the15cases subcarinal lymph node metastasis,12cases with other regional lymph node metastasis,3cases was single subcarinal lymph node metastasis, subcarinal lymph node metastasis was related with pathological changes Infiltrating depth and lesion length(rs=0.300,P=0.041;rs=0.247,P=0.008).It was also related with the ratio of length-short diameter and the shortest diameter in CT(rs=0.448,P=0.009; rs=0.378,P=0.028).It showed15patients with positive subcarinal lymph node in Postoperative pathology.There are10cases of CT diagnosis are positive, consistent with the postoperative pathological results,3cases are calcified lymph nodes,2cases are not found swelling lymph nodes. The concordance rate between the subcarinal lymph node in imaging diagnosis and postoperative pathological is89.66%, specificity is94.44%,sensitivity is only66.67%,the misdiagnosis rate is5.56%,the rate of missed diagnosis was33.33%,positive predictive value was71.43%,negative predictive value of93.15%.Through consistency inspection,Difference was statistically significance(Kappa=0.628,P<0.001).Conclusion:(1)The subcarinal lymph node metastasis rate in the middle and lower segment of the Thoracic esophageal carcinoma is higher than others,should be cleaned as esophageal regional lymph node(17.24%,15/87).(2)It has relationship between subcarinal lymph node metastasis and pathological changes of infiltration depth,length.Subcarinal lymph node metastasis rate tends to increase, with the increase of the length of lesion and infiltration depth; It also has relationship between subcarinal lymph node metastasis and the ratio of length-short diameter and the shortest diameter,lymph node subcarinal lymph node metastasis rate tends to increase,with CT in lymph nodes of length to diameter ratio and the increase of short diameter size;(3)It has consistency between Subcarinal lymph node of CT diagnosis and postoperative pathology.CT diagnosis of subcarinal lymph node cleaning has a certain clinical significance.