The Research Of Regularity Of Lymph Node Metastasis In Thoracic Esophageal Squamous Cell Carcinoma

Objective: To study the regularity and influencing factors of lymph node metastasis in thoracic esophageal squamous cell carcinoma,and explore the surgical approach and lymph node dissection area of thoracic esophageal squamous cell carcinoma,so as to provide a theoretical basis for standardized lymph node dissection and postoperative survival.Methods: The clinical data of 548 patients with thoracic esophageal squamous cell carcinoma who underwent radical esophagectomy and lymph node dissection from January 2015 to September 2017 in Department of thoracic surgery,Cancer Hospital of Sichuan province were retrospectively analyzed.The relationship between regularity of each regional lymph node metastasis and tumor location,tumor length,T stage,G stage,vascular tumor thrombus and nerve invasion were analyzed.All data were statistically processed with SPSS24.0 statistical package.Results: 1.Among the 548 cases of thoracic esophageal squamous cell carcinoma,334 cases had lymph node metastasis,and the total lymph node metastasis rate was 60.9%.A total of 15105 lymph nodes were cleaned,1099 lymph nodes were transferred and the metastatic ratio of lymph node was 7.3%.The several groups with the most lymph node dissection were 2559 subcarinal lymph nodes,2329 paracardial lymph nodes,1840 left laryngeal recurrent lymph nodes,1689 right recurrent laryngeal lymph nodes,and 1072 lymph nodes beside the left gastric artery separately.Subcarinal lymph nodes metastasis were 66 cases(transfer rate 12%,transfer degree 4.5%),paracardial lymph nodes metastasis were 97 cases(transfer rate 20.3%,transfer degree 6.8%),left recurrent laryngeal nerve lymph nodes metastasis were 106 cases(transfer rate 19.3%,transfer degree 8.4%),the right recurrent laryngeal nerve lymph nodes metastasis were 159 cases(transfer rate 29%,transfer degree 14%),left gastric artery lymph nodes metastasis were 64 cases(transfer rate 20.2%,transfer degree 9.3%).The rate of lymph node metastasis in the chest was the highest,up to 52.4%.Among the thoracic lymph nodes,the metastasis rate of the superior mediastinal lymph node was the highest,up to 41.6%.2.The upper thoracic esophageal squamous cell carcinoma mainly metastases to the upper mediastinal region,with a metastasis rate of 59.4%.Among this region,the rate of the right recurrent laryngeal nerve lymph node metastasis is the highest(40.6%),followed by the right supraclavicular lymph node(30.8%).The lymph nodes in the middle thoracic esophageal squamous cell carcinoma had a higher metastatic rate in the cervicothoracic and abdominal three-field,the highest was still in the upper mediastinum,up to 38%,and among the upper mediastinum,the rate of the lymph node metastasis in the right side of the recurrent laryngeal nerve was the highest(27.2%).The lymph nodes in the lower thoracic esophageal squamous cell carcinoma were mainly located in the upper abdomen and the middle and lower mediastinum,with the highest metastasis rate in the upper abdomen,which was 41.7%.The lymph nodes in the para-hepatic artery,the para-splenic artery and the celiac axis were no metastasis in the upper thoracic esophageal cancer,but had some metastasis rate in the middle and lower thoracic esophageal cancer,reached 6.3-13.5%.3.Single factor analysis of lymph node metastasis regularity in thoracic esophageal squamous cell carcinoma showed that lymph node metastasis rate was significantly related to tumor length,depth of invasion,differentiation degree,vascular tumor thrombus and nerve invasion(P<0.05),but not related to gender,age and tumor location(P>0.05).Multivariate regression analysis showed that lymph node metastasis was related to the degree of differentiation,depth of invasion and tumor thrombus(P<0.05),which was not related to tumor length and nerve invasion(P>0.05).4.The left recurrent laryngeal nerve lymph node metastasis risk of single factor analysis showed that the left recurrent laryngeal nerve lymph node metastasis had relationship with tumor location,tumor length,depth of infiltration,degree of differentiation(P<0.05),has nothing relationship with gender,age,vascular invasion,perineural invasion(P>0.05).Multiple regression analysis showed that lymph node metastasis was associated with tumor location,tumor length,depth of invasion,and degree of differentiation(P<0.05).5.The right recurrent laryngeal nerve lymph node metastasis risk of single factor analysis showed that the right recurrent laryngeal nerve lymph node metastasis had relationship with tumor location,vascular invasion,perineural invasion(P<0.05),has nothing relationship with gender,age,tumor size,infiltration depth,differentiation degree(P>0.05).Multiple regression analysis showed that lymph node metastasis was associated with tumor location,vascular tumor suppository(P<0.05),and not related to nerve invasion(P>0.05).6.Univariate analysis of risk of subcarinal lymph node metastasis showed that subcarinal lymph node metastasis was related to tumor length,depth of invasion,vascular tumor thrombus and nerve invasion(P<0.05),but not related to gender,age,tumor location and degree of differentiation(P>0.05).Multiple regression analysis showed that lymph node metastasis was associated with tumor length and vascular tumor suppository(P<0.05),not related to infiltration depth and nerve invasion(P>0.05).Conclusion:1.The superior mediastinum lymph nodes had the highest metastasis rate on thoracic esophageal squamous cell carcinoma.We suggest that right thoracic approach should be selected for mediastinal lymph node dissection.2.The degree of differentiation,depth of infiltration and vascular tumor thrombus were independent risk factors for lymph node metastasis of thoracic esophageal squamous cell carcinoma.3.The lymph node metastasis rate of the left and right recurrent laryngeal nerve was high,and related to the site of the tumor.These lymph nodes were recommended to clean up routinely.4.The lymph nodes of the subcarinal lymph nodes had a certain chance of metastasis above T2.We suggested that the subcarinal lymph nodes should be routinely dissected in the thoracic esophagus squamous carcinoma above T2.5.There was a certain chance of metastasis in the common hepatic artery lymph node,the splenic artery and celiac axis lymph node in the middle and lower esophageal squamous cell carcinoma.We suggested that these lymph nodes shold be routinely dissected in the middle and lower esophageal squamous cell carcinoma.