title: Pattern of lymph node metastases and its implication in radiotherapeutic clinical target volume in patients with thoracic esophageal squamous cell carcinoma: A report of 1077 cases.
abstract: OBJECTIVE
  To study the pattern of lymph node metastases after esophagectomy and clarify the clinical target volume (CTV) delineation of thoracic esophageal squamous cell carcinoma (ESCC).
  
  
  METHODS
  Total 1077 thoracic ESCC patients who had undergone esophagectomy and lymphadenectomy were retrospectively examined. The clinicopathologic factors related to lymph node metastasis were analyzed using logistic regression analysis.
  
  
  RESULTS
  The rates of lymph node metastases in patients with upper thoracic tumors were 16.7% (9/54) cervical, 38.9% (18/54) upper mediastinal, 11.1% (6/54) middle mediastinal, 5.6% (3/54) lower mediastinal, and 5.6% (3/54) abdominal, respectively. The rates of lymph node metastases in patients with middle thoracic tumors were 4.0% (27/680), 3.8% (26/680), 32.9% (224/680), 7.1% (48/680), and 17.1% (116/680), respectively. The rates of lymph node metastases in patients with lower thoracic tumors were 1.0% (5/343), 3.0% (10/343), 22.7% (78/343), 37.0% (127/343), and 33.2% (114/343), respectively. T stage, the length of tumor and the histological differentiation emerged as statistically significant risk factors of lymph node metastases of thoracic ESCC (P < 0.001).
  
  
  CONCLUSIONS
  T stage, the length of tumor and the histologic differentiation influence the pattern of lymph node metastases in thoracic ESCC. These factors should be considered comprehensively to design the CTV for radiotherapy (RT) of thoracic ESCC. Selective regional irradiation including the correlated lymphatic drainage regions should be performed as well.
authors.affiliation: Department of Radiation Oncology (Chest Section), Shandong Cancer Institute (Hospital), Jinan, Shandong Province, PR China.
authors.forename: Wei
authors.initials: W
authors.lastname: Huang
authors.forename: Baosheng
authors.initials: B
authors.lastname: Li
authors.forename: Heyi
authors.initials: H
authors.lastname: Gong
authors.forename: Jinming
authors.initials: J
authors.lastname: Yu
authors.forename: Hongfu
authors.initials: H
authors.lastname: Sun
authors.forename: Tao
authors.initials: T
authors.lastname: Zhou
authors.forename: Zicheng
authors.initials: Z
authors.lastname: Zhang
authors.forename: Xibin
authors.initials: X
authors.lastname: Liu
mesh_terms: D000328:Adult; D002294:Carcinoma, Squamous Cell / Q000473:pathology* / Q000532:radiotherapy*; D004938:Esophageal Neoplasms / Q000473:pathology* / Q000532:radiotherapy*; D005260:Female; D006801:Humans; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D020266:Radiotherapy, Conformal; D016896:Treatment Outcome