Abstract Objective To investigate the thoracic lymph node metastasis rate and transfer direction and the contact between the various pathology related factors. Methods A retrospective analysis of 149 cases with lymph node metastasis of esophageal cancer radical surgery in patients with clinical and pathological data. 纵隔>胃左动脉区>食管旁，其中肿瘤浸润深度和分化程度">Results Among 765 lymph node metastasis by 336, the total transfer rate of 43.9%, the transfer rate of the lymph nodes: supraclavicular> mediastinal paraesophageal> left gastric artery>, in which the tumor infiltration depth and degree of differentiation with the difference between the rate of lymph node metastasis was significantly (P = 0.003, P = 0.049), while no significant differences between tumor, lesion length and transfer rate. Conclusion esophageal vertical transfer rate is much greater than the lateral transfer, paraesophageal lymph nodes can not be used as an outpost of esophageal cancer lymph node treated, the line neck chest and abdomen three districts, extensive lymph node dissection, to reduce the legacy of metastatic lymph nodes, and improve patient outcomes.
Key words esophageal cancer; lymph node metastasis; transfer rule
Esophageal cancer is one of the common malignant tumors in China, has long been a serious threat to people’s health. Recurrence and metastasis are the main factors affecting the efficacy of esophageal cancer, lymph node metastasis of esophageal cancer is the most common transfer route is also the most important factor affecting the esophageal cancer prognosis. In order to understand the characteristics of lymph node metastasis of thoracic esophageal cancer and its impact on the prognosis of patients, lymph node status after surgical resection of esophageal cancer specimens in our hospital from January 1993 to December 2002 study to explore a variety of pathological the scope and direction of the related factors of lymph node metastasis, and transfer, especially with the relationship between the transfer rate to provide more accurate experimental basis to find out the rules and characteristics of lymph node metastasis, surgical treatment and radiation therapy for esophageal cancer, are as follows.
1 Data and methods
January 1993 to December 2002 a total of esophageal cancer 326 cases of radical surgery, all patients underwent regional lymph node dissection, which found that in 149 cases of surgical specimens with lymph node metastasis. This group of 149 patients with lymph node metastasis in patients with esophageal cancer, 106 cases of male and female 43 cases. The male to female ratio was 2.5:1. Age 30 to 77 years, with a median age of 54 years old. The ethnic distribution of this group of patients is the Han 80 cases, the Uighur 44 cases, 24 cases in Kazakh, Hui 1 cases.
进行。">The clinical and pathological data statistics the <common malignancy specification>. With reference to international esophageal Statute draining lymph node grouping grouping, transfer rate = found that the metastatic lymph node number / Clear lymph node number of × 100%.
Statistical analysis using χ2 test.
2.1 Clinical and pathological findings
9cm者14例。">149 patients with esophageal cancer lesion length <3cm 8 cases, 3.1 to 5cm in 34 cases, 5.1 to 7cm those 57 cases, 36 cases of 7.1 to 9cm by> the 9cm those 14 cases. Clinical stage II B 23 cases, Ⅲ of 119 cases and 7 cases, Ⅳ stage. The tumor is located in the upper thoracic, chest segment were 105 cases, chest under paragraph 38. Depth of tumor invasion T1, 2 cases, T2 those 22 cases, T3 in 99 cases, T4 in 26 cases.
The pathological type specimens for the the the medulla 78 cases, 67 cases of ulcer type, fungating four cases. The histological type 140 cases of squamous cell carcinoma, four cases of squamous carcinoma, adenocarcinoma, 5 cases.
2.2 lymph node status
149 cases of lymph node metastasis in esophageal resection specimens were found in 765 lymph node metastasis in 336, the total transfer rate of 43.9%. The relationship between the various pathological changes in the rate of lymph node metastasis in Table 1 to 4.
0.05），病变浸润深度与淋巴结转移率之间、肿瘤组织学分化程度（低">By the statistical treatment, the tumor and lymph node metastasis rate between lesion length and rate of lymph node metastasis showed no significant sex (P> 0.05), lesion between infiltration depth and lymph node metastasis rate, degree of tumor histology (low was no significant difference between the different parts of the upper thoracic lymph node metastasis rate, moderately differentiated squamous cell carcinoma with well-differentiated squamous cell carcinoma) with lymph node metastasis rate between the difference was statistically significant (P <0.01 and P <Table 1 tumor and lymph node metastasis rate ( P = 0.557), lymph node metastasis rate between the different parts of the middle thoracic significant difference (P = 0.001), lymph node metastasis rate between the different parts of the lower thoracic significant difference (P = 0.000) Table 2 tumor size (length) lymph node metastasis rate
Lesion length (cm) chest segment transfer rate (%) chest segment transfer rate (%) chest lower segment transfer rate (%) Total (%) <3031.0 (11/36) 20.0 (2/10) 28.3 (13/46) 3.1 ~ 554.5 (6/11) 41.6 (37/89) 38.8 (33/85) 41.1 (76/185) 5.1 to 7100.0 (1/1) 44.4 (91/205) 41.7 (20/48) 44.1 (112/254 950.0(3/6)51.0(26/51)51.4(18/35)51.1(47/">) 7.1 to 954.5 (6/11) 45.9 (45/98) 46.8 (37/79) 46.8 (88/188)> 950.0 (3/6) 51.0 (26/51) 51.4 (18/35) 51.1 (47 / 92) Total 55.2 (16/29) 43.8 (210/479) 42.8 (110/257) 43.9 (336/756)
Between the different parts of the esophageal cancer lymph node metastasis rate was no significant difference (P = 0.444), lymph node metastasis rate between different lesion length was no significant difference (P = 0.091) Table 3 histological type and lymph node metastasis rate
Tissue types thoracic segment transfer rate (%) chest segment transfer rate (%) chest lower segment transfer rate (%) Total (%) in differentiated squamous cell carcinoma 54.5 (12/22) 40.7 (94/231) 31.5 (29/92) 45.5 (157/345), squamous carcinoma, poorly differentiated squamous cell carcinoma 57.1 (4/7) 46.9 (107/228) 43.6 (51/117) 46.0 (162/352) 033.3 (5/15) 033.3 (5/15) adenocarcinoma Total 080.0 (4/5) 62.5 (30/48) 64.2 (34/53) 55.2 (15/29) 43.8 (210/479) 42.8 (110/257) 43.9 (336/756)
The rate of lymph node metastasis in esophageal cancer between the different types of pathology significant difference (P = 0.049) Table 4 depth of invasion and lymph node metastasis rate
The infiltration depth upper thoracic metastasis rate (%) the middle thoracic metastasis rate (%) of the lower thoracic metastasis rate (%) Total (%) T1018.2 (2/11) 018.2 (2/11) T2100.0 (1/1) 36.6 (26/71) 29.0 (9/31) 35.0 (36/103) T353.6 (15/28) 43.4 (131/302) 39.0 (57/146) 42.6 (203/476) T4053.7 (51/95 ) 55.0 (44/80) 54.3 (95/175) Total 55.2 (16/29) 43.8 (210/479) 42.8 (110/257) 43.9 (336/756)
The esophageal different infiltration depth between lymph node metastasis rate were significant differences (P = 0.003) 0.05). As can be seen from Table 1, the middle of cancer on the esophagus, lateral transfer, also can transfer up to the supraclavicular or migrate down into the left gastric artery area, lower thoracic tumors except lateral transfer, mainly downward shift to the left gastric artery area (62.2%), no case of supraclavicular lymph node metastasis.
Currently using three cuts and whole esophagus, esophageal resection for wide excision of esophageal lesions surgery for lymph node dissection has brought a lot of convenience. The clinical and pathological data confirmed that esophageal cancer is more than one center of the tumor, and many patients the lesions were skip metastasis . Therefore, simple excision of the diseased esophagus, it is difficult to guarantee that the lesions completely excision, easily understood tumor recurrence. An important factor affecting the surgical treatment of esophageal lymph vertical, horizontal transfer of the extent that the transfer rate . This is related to the anatomical structure of the esophagus, histological features. The lymphatic drainage of the esophagus is mainly wale directions drainage, lymphatic wale rampant Lymphatics 6 times, the lymph node metastasis was mainly on the regional and the bidirectional transfer, therefore the transfer of thoracic esophageal first tumor paraesophageal lymph nodes, and upper thoracic esophageal lymph nodes along the esophagus to the cervical lymph node metastasis; the middle thoracic cancer is not only up to the upper thoracic paraesophageal, paratracheal, deep cervical and supraclavicular lymph node metastasis, also be transferred to the downward the cardia next perigastric lymph nodes in the left gastric perivascular; the lower thoracic downstream by lymph node metastasis mainly . The lymph node metastasis group characteristics and reported in the literature are basically the same. Can be seen from Table 1 tumor and lymph node metastasis rate between the removal of lymph nodes in the esophagus is the largest, accounting for 72.9% of the total number of lymph nodes (558/765), but the transfer rate is only 39.6 percent, far below the supraclavicular, mediastinal and left gastric artery lymph nodes. Its significance lies in the surgery only large lesions esophageal range excision is insufficient, due to the esophageal adventitia esophagus close to the lymph node, the surgery may be together with the esophageal resection without line dissection. Sometimes the surgeon see the enlarged lymph nodes, pathological examination revealed mistaken to give up further dissection of the lymph node is the sentinel lymph node metastasis is found next to the esophagus. The material of the group prompted the tumor is located in the middle by his supraclavicular and mediastinal lymph node metastasis than paraesophageal (80%, 66.7% versus 40.6%), while the lower esophagus cancer, left gastric artery District metastasis (62.2% higher than paraesophageal 35.0%), only the upper esophagus cancer, its paraesophageal lymph node metastasis rate is the highest, but these differences were not statistically significant.
Transfer rate from cancer of the lymph nodes, lymph node dissection is bigger and more conducive to improve the prognosis of patients with esophageal lymph nodes can not be used as a lymph node the esophageal surgery of outpost treat esophageal vertical transfer rate is much greater than the level of transfer.
The significant difference between this group of materials esophageal squamous cell infiltration depth and degree of differentiation and lymph node metastasis rate. This is related to the biological behavior of the tumor. Deeper tumor-infiltrating T stage the higher, the transfer occurred more opportunities, but also prompted the growth of tumor infiltrating the faster. The same organization learn the higher grade of the tumor, the higher the degree of malignancy. The greater the likelihood of invasion and metastasis. This is also consistent with the reports of other scholars . As for esophageal adenocarcinoma, the relatively small number of patients in this group of materials with esophageal squamous cell differences in the degree of transfer could not be evaluated. Segment of cancer can occur on the chest supraclavicular and the transfer of the left gastric artery, while the lower thoracic cancer often transferred to the mediastinum and the left gastric artery area. We are in favor of removal of sufficient length of the esophagus plus widely lymph nodes clear the surgical way, especially under the cut end should include gastric body, dissection of the lymph nodes range should include stomach left artery area, the implementation of neck, chest, abdomen three District lymph node dissection, in order to achieve the radical of effect, improve the survival rate.
The thoracic esophageal cervical lymph node metastasis rate of 26.0%, the line of the neck, chest, abdomen, “the three-field lymph node dissection in patients with 5-year survival rate was significantly higher than the chest, abdomen or neck, chest" wild “cleaning patients (1) on better physique lesions without extensive foreign invasion, extensive lymph node metastasis, the thoracic esophagus subtotal lymph node dissection, neck, chest, abdomen area, radical surgery [5,6]. Decline in the possibility of the “three-field lymph node dissection should be limited to relatively early lesions in patients with the event of extensive lymph node metastasis, radical surgery," the three-field lymph node dissection is not meaningful. For advanced cases, the tumor outside invasion severe lymph node metastasis in a wide range of cases, should abandon the operation, the implementation of the comprehensive treatment of radiotherapy and chemotherapy, remission obstruction, improve the patient’s quality of life is the main purpose.