Analysis Of The Related Risk Factors Of The Lymph Node Metastasis In Patients With Superficial Esophageal Carcinoma

Backgroud:Esophagel cancer ranks sixth in the most common malignant tumor of the world. In our country the esophageal cancer has a high incidence and mortality. Generally speaking, esophageal cancer usually has no obvious clinical symptom at early stage. When a patient comes to see a doctor for obstruction in eating, the esophageal cancer usually has come to a late stage, and the prognosis is always very bad. The treatment of the esophageal cancer is surgical resection in the past, which brings about trauma and serious complications. With the development of the digestive endoscopic technology and the popularity of chromoendoscopy, the early detection rate of esophageal cancer has improved greatly. And the endoscopic treatments like endoscopic mucosal resection(EMR) and endoscopic submucosal dissection(ESD) have developed very fast. The wall of esophageal is divided into 4 parts:mucosal layer、submucosal layer、muscularis propria layer、fibrous coat. Superficial esophageal cancer(SEC), also known as the early esophageal carcinoma in the past, which is difined as limited to the layer of mucosa or submucosa, no matter whether or not there is lymph node metastasis. If there is no lymph node metastasis, the endoscopic treatment is recommended to the patient who has SEC, and the severe trauma and complications of the surgical treatment are avoided. Otherwise, surgery with lymph node resection should be adopted.Aim:To predict lymph node metastasis in cases of superficial esphageal carcinoma before surgery, and it would allow the identification of some patients who do not need surgical resction after endoscopic local resection.Method:From April 2010 to April 2015 in our hospital a total of 93 patients with superficial esophageal carcinoma underwent subtotal esophageal resction with lymph node resection. On the basis of those clinicopathologic data, such as depth of invasion pathological type, differentiation degrees, tumor size, macroscopic type, the risk factors for lymph node metastases are discussd.Results:Multivariate analysis showed that the depth of invasion is an independent risk factors of the lymph node metastase. The differentiation degrees、tumor size、 macroscopic type are closely related with lymph node metastasis. Patient with esophageal carcinomia that showed submucosal invasion、a non-flat shape、and low differentiation degree would have high lymph node metastasis than the other patients. The lymph node metastasis of m1、m2、m3、sm1、 sm2、sm3 of superficial esophageal cancer respectively are 0%、0%、5.3%、8.7%、17.6% and 37.5%. There are significant difference between groups(P<0.05). Tumor diameter>3cm、non-flat shape (0-Ⅰ and 0-Ⅲ) and the invasion of sm2 has a very high lymph node metastasis.Conclusion:Depth of invasion、differentiation degrees% tumor size、macroscopic type are closely associated with lymph node metastasis. The depth of invasion is an independent risk factor of lymph node metastasis. For the superficial esophageal carcinoma, of its invasion is limited to the m1 or m2,there is minimal risk of lymph node metastasis, and it is recommended to have a endoscopic treatment which is safe and effective. If the preoperative examination turns to be a sm2 or sm3, the surgical excision should not be avoided. For the patients after the endoscopic resection, if the pathology prove the invasion has exceeded sm1,and a low differentiation degree, additional surgery is needed and the related lymph nodes should be removed.