| Objectives Esophageal squamous cell carcinoma(ESCC)is a common malignant tumor,and the abdominal lymph nodes presented above the celiac trunk were classified as regional lymph nodes in the 7th Edition of American Joint Committee on Cancer(AJCC)guidelines.The aim of this study was to collect cases with abdominal lymph nodes metastasis in ESCC patients and analyzed to reveal their clinical features and prognosis.Materials and methods 181 patients from January 2006 to December 2009 in our hospital underwent the radical esophagectomy and 3-field lymph node dissection were selected,they were pathologically confirmed as ESCC and abdominal lymph node metastasis?Group differences was compared using the chi square test and FISHER exact test for categorical variable data.Survival analysis was generated by Kaplan-Meier method and compared by Log rank test.Cox regrssion proportional hazards model was used for multivariate analysis.Results 1)The left gastric artery lymph node accounting for 58%(105/181)was the most common station in the abdominal lymph node metastatic sites,followed by the left cardiac lymph node 43.1%(78/181),gastric lymph node 23.2%(42/181),right cardiac lymph node 16.6%(30/181),distant upper abdominal lymph node metastasis 3.9%(7/181).2)The overall median survival time was 30 months,and the 1-year?3-year?5-year overall survival(OS)rate was 77%,46%,and 13%,respectively.3)The metastatic site of lymph node were classifiedthe as neck,chest and abdomen.Univariate analysis showed no significant difference between survival between 1 regional and 2 regional lymph node metastases(p=0.947),but both of them had better prognosis than 3 regional lymph node metastases(P < 0.001).4)The 1-year ? 3-year ?5-year 0S of metastasis to cardiac lymph nodes(54 cases),left gastric artery lymph nodes(120 cases),distant upper abdominal lymph node(7 cases)were 76%,53%,14%;77%,43%,13%;71%,29%,0.(P=0.195)5)When the number of positive abdominal lymph node was divided into 1?2 or more than 2 pieces,the 1-,3-and 5-year OS for each groups were 84%,57%,13%;71%,47%,25%;68%,27%,3%(P=0.001).6)The p N1 stage,p N2 stage,p N3 stage of 1-year?3-year?5-year 0S were 88%,77%,64%;68%,49%,20%,22%,11%,6%(P < 0.001).7)The degree of positive lymph node ratio was divided into A groups:?10%,B groups: > 10%,? 20%,C groups: > 20%,A group of 76 cases,B group of 58 cases,C group of 51 cases.The 1-year?3-year?5-year OS of the three groups were 81%?65%?22%;81%?43%?7%;63%?20%?6%(P<0.001),respectively(P < 0.001).8)Univariate analysis showed that age,tumor location,pathological T stage,pathological N stage,tumor thickness,tumor thrombus and positive number of abdominal lymph node,positive lymph node ratio and postoperative chemotherapy were prognostic factors.9)Multiple cox regression revealed that positive lymph node ratio and postoperative chemotherapy were independent prognostic factors for survival.Conclusions The distribution rate of the left gastric artery lymph nodes and cardiac lymph nodes were the highest in the ESCC patients with abdominal lymph node metastasis of whom were associated with poor overall survival.The number of metastatic lymph nodes,degree of positive lymph node ratio,N stage were related to prognosis when lymph nodes transfer to upper abdominal.While the lymph node metastasis sites had no effect on overall survival for the whole groups that could be regard as the same region.Low positive lymph nodes ratio and postoperative chemotherapy were the powerful and independent prognostic factors related to the outcome. |
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