Prevalence And Predictors For Lymph Node Metastasis Of PT1 Stage Esophageal Squamous Carcinoma

Background and ObjectiveEsophageal cancer is considered as one of the most common gastrointestinal tract malignant tumors in China.The morbidity occupies 5th in malignancy and the mortality rank 4th of the malignancy.Surgical resection is main treatment of esophageal cancer.The morbidity rate with esophagectomy ranges from 20% to 50%,and the 30-day mortality rate ranges from 3% to 10%.Although the treatments of esophageal cancer have greatly improved in the fields of surgery,chemotherapy and radiotherapy,the prognosis remains poor,with 5-year overall survival rate ranging from 15% to 20%.The five-year survival rate of early esophageal cancer is 92.6% to 95%.Three-year OS of surgery after neoadjuvant chemoradiation was only 59.6%.Lymph node metastasis is an important factor affecting the prognosis,and an important factor in the treatment of pT1 ESCC.The rate of lymph node metastasis below the mortality rate of esophagectomy should be a prerequisite for endoscopic Endoscopic therapy has the advantage of high effectivity and safety for intra-mucosal adenocarcinoma,with satisfactory prognosis.However,situation goes different forT1 b tumor.The treatment strategy remains controversial for a high rate of lymph node metastasis.However,studies about T1 patients are usually small sample researches for more than 90% patients are diagnosed in advanced stage.Although Europe and the United States have already fully studied the early stage esophageal adenocarcinoma,the differences in pathogenesis,epidemiology,predilection site,and tumor biological characteristics between Chinese and Western pathological types are quite different.The effects of surgical methods such as left thoracotomy and common three incisions,the technical difficulty of bilateral recurrent laryngeal nerve node dissections,and high complications associated with dissection,development of recurrent laryngeal nerve node dissections is limited.Thus,the dissection is just not completely two-field or there-field lymphadenectomy in most hospitals in China.Affected by surgical methods and incomplete lymphadenectomy,lymph node metastasis rate and risk factors in pT1 thoracic esophageal squamous cell carcinoma still lack evidence of high quality evidence-based medical evidence based on complete two-field lymphadenectomy.The aim of this study was to evaluate the metastasis rate and the risk factors of lymph node metastasis in patients with pT1 ESCC,providing guidance on treatment for pT1 ESCC.MethodWe retrospectively analyzed the data from 271 patients from December 2014 to January 2017 in Henan Provence Tumor Hospital,who underwent esophagectomy for esophageal squamous carcinoma and definitive diagnose of pT1 stage.Clinical data and postoperative pathological features were collected and analyzed.The rate of lymph node metastasis was assessed and risk factors for lymph node metastasis were analyzed using univariate analyses and Logistic regression.ResultsLymph node metastasis occurred in 4/90(4.4%)T1a patients and 54/181(29.8 %)T1b patients,showing statistically difference(P <0.001,OR = 9.142).Univariate analysis proved T stage,maximum lesion thickness,difference degree(P<0.001)and vessel invasion(P<0.001)were associated with lymph node metastasis.Logistic regression analysis showed T stage(p <0.001)differentiation degree(P<0.001)and vessel invasion(P<0.05)were independent risk factors for lymph node metastases.There was no vessel-invasion in T1 a tumor.For T1 a stage tumor,the rate of LN metastasis was 2.7 % in the Well-Moderately differentiated group(2/73)and 2.7 % in the Well-Moderately differentiated and none-Vessel invasion group(2/73).For T1 b tumor,the rate of LN metastasis was 18.5 % in the Well-Moderately differentiated group(20/108),27.4 % in the none-Vessel invasion group(40/162)and 16.7 % in the Well-Moderately differentiated and none-Vessel invasion group(17/92).there was significance difference in lymph node metastasis rate among each group(P <0.05).The metastasis rate of recurrent laryngeal nerve lymph node was 18.5%,left recurrent laryngeal nerve lymph node and right were 7.5%(21/271)and 15.6%(44/271),respectively.There was no significant difference in lymph node metastasis rate between the tumor locations(P>0.05).The rate of skip metastasis was 17.2% and no significant difference found associated with tumor location(P>0.05).ConclusionsDifferentiation degree,p T staging and vessel invasion were identified to be independent risk factors for lymph node metastases of pT1 ESCC.Surgical resection followed by entirely two-fild lymph node dissection still should be recommended for T1 b stage ESCC patients for the high metastasis prevalence.The metastasis of recurrent laryngeal nerve node was not associated with tumor location.There is no difference in skip transitions associated with tumor location.