[Analysis of lymph node metastases of 217 cases of thoracic esophageal carcinoma and its impact on prognosis].
OBJECTIVE
At present, the range of lymph node dissection in treatment of thoracic esophageal cancer is still controversial. This study was designed to explore the status of lymph node metastases of thoracic esophageal carcinoma and its influence on the prognosis and to seek reasonable dissecting range of lymph nodes.


METHODS
A retrospective study was performed on the clinical data of 217 patients who had underwent radical operation through three-field lymphadenectomy. Nine distinguishing clinicopathological factors possibly influencing survival rate were chosen. A multivariate analysis of these factors was performed by the computerized Cox proportional hazards model.


RESULTS
The 1-, 3-, and 5-year survival rates of all patients were 82.6%, 59.8%, and 48.8%, respectively. The lymph node metastasis rate was 62.6% and the leaping metastasis rate of lymph nodes was 5.5%. In 3989 lymph nodes dissected, metastases were detected in 454 (11.38%). The lymph node metastasis rates present in neck, thoracic mediastinum, and abdominal cavity were 31.7%, 21.2%, and 12.1% in upper-thoracic esophageal carcinoma, 21.9%, 30.5%, and 15.6% in middle-thoracic carcinoma, 9.75%, 12.7%, and 34.5% in lower-thoracic carcinoma, respectively. Degree of tumor differentiation, depth of tumor invasion, and lymphatic vessels invasion were the factors influencing lymph nodes metastases, but the length of tumor was not. According to multivariate analysis, depth of tumor invasion, tumor differentiation, the number of lymph nodes metastatic field, and tumor location were of prognostic significance. With the increasing of the number of lymph nodes metastatic field, the survival rate of the patients dropped gradually(P = 0.0284).


CONCLUSIONS
Lymph node metastasis especially the number of lymph node metastatic field is one of key factors affecting the prognosis of patients. Because of the upward, downward, and leaping spreading of esophageal carcinoma cells to the lymph nodes, the patients with thoracic esophageal carcinoma should be given radical operation through three-field lymphadenectomy to promote the 5-years survival rate.
An
Feng-Shan
FS
Esophageal Carcinoma Research Center, Jieyang, Guangdong, 522000, PR China. FlashRains@21cn.com
Huang
Jin-Qiu
JQ
Chen
Shao-Hu
SH
D000328:Adult; D000368:Aged; D004938:Esophageal Neoplasms / Q000401:mortality / Q000473:pathology*; D005260:Female; D006801:Humans; D016015:Logistic Models; D008197:Lymph Node Excision; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D015996:Survival Rate