Explore Staging Criteria Of Lymph Node Metastasis Of Esophageal Squamous Cell Carcinoma After Surgery

Objective:Lymph node(LN)-related factors including the number of LN metastasis,the distance of LN metastasis,the extent of LN metastasis,and the LN ratio(LNR)are strong prognostic indicators for esophagealsquamous cell carcinoma(ESCC)patients.This study aims to provide a more detailed grouping through the research of the number of LN metastasis,the distance of LN metastasis,the extent of LN metastasis,and the LN ratio(LNR),so as to help doctors select the most appropriate postoperative management strategy.Methods:This study retrospectively analyzed the data of 326 patients with esophageal squamous carcinoma who were demonstrated after radical resection in the Fourth Hospital of Hebei Medical University from January 2008 to November 2012.The prognostic factors of this study included gender,age,tumor location,tumor size,the number of positive lymph nodes(N stage),the depth of tumor invasion,the degree of tumor differentiation,the number of lymph node dissection,Postoperative chemoradiotherapy,smoking history,drinking history the distance of LN metastasis,the extent of LN metastasis,and the LN ratio(LNR).The above data were analyzed by SPSS19.0 statistical software:Kaplan-Meier survival curve and Log-Rank test were used for univariate survival analysis,and Cox regression was used for multivariate survival analysis.Results:Follow-up was carried out to death of patients or to end of November 2017.The 3-year and 5-year DFS was 59.8% and 43.6% for all 326 patients after surgery respectively.Univariate analysis showed that gender,tumor size,the number of positive lymph nodes(N stage),the depth of tumor invasion,the degree of tumor differentiation,Postoper ative chemoradiotherapy,the distance of LN metastasis,the extent of LN metastasis,and the LN ratio(LNR)were associated with DFS(P<0.05).Multivariate analysis show that N stage(P=0.023<0.05),the depth of tum or invasion(P=0.000<0.05),the LN ratio(LNR)(P=0.049<0.05),and Postope rative chemoradiotherapy(P=0.000<0.05)were the independent prognostic factors for DFS in these patients.The 3-year and 5-year OS was 63.1% and 46.0% for all 326 patients respectively.Univariate analysis sho wed that gender,tumor size,the number of positive lymph nodes(N stage),the depth of tumor invasion,the degree of tumor differentiation,Postoperative chemoradiotherapy,the distance of LN metastasis,the extent of LN metastasis,and the LN ratio(LNR)were associated with OS(P<0.05).Multivariate analysis show that N stage(P=0.032<0.05),the depth of tumor invasion(P=0.000<0.05),the LN ratio(LNR)(p=0.048<0.05),and Postoperative chemoradiotherapy(P=0.000<0.05)were the independent prognostic factors for OS in these patients.Conclusions:1.The postoperative N staging is an independent prognostic factor for DFS and OS in patients with esophageal squamous carcinoma after surgery.The survival rate decreases with the increase of the number of positive lymph nodes.2.The LN ratio is an independent prognostic factor for DFS and OS in patients with esophageal squamous carcinoma after surgery.The survival rate decreases with the increase of the ratio of positive lymph nodes.3.Based on the number of lymph node metastasis,combined withthe LN ratio(LNR)may be better lymph node staging method,which can better predict the prognosis of patients and guide the treatment.