title: [Esophageal adenocarcinoma: the clinicopathologic features, patterns of lymph node metastasis and its influencing factors].
abstract: OBJECTIVE
  To investigate the clinicopathological characteristics, patterns of lymph node metastasis and the influencing factors in esophageal adenocarcinoma.
  
  
  METHODS
  A total of 201 cases of esophageal adenocarcinoma were selected for this study, including 89 cases of pure adenocarcinoma, 57 cases of adenoacanthoma cell carcinoma, 33 cases of mucoepidermoid carcinoma and 22 cases of adenoid cystic carcinoma. A total of 2026 lymph nodes were dissected with an average of 10 lymph nodes. The rule of lymph node metastasis in patients with esophageal adenocarcinoma was analyzed, and the risk factors for lymph node metastasis were identified.
  
  
  RESULTS
  Esophageal adenocarcinoma in the middle thoracic esophagus accounted for 50.7% of all patients, and 43.8% in the lower thoracic esophagus. Ninety out of 201 cases (44.8%) had lymph node metastasis. 322 lymph nodes were positive for metastatic adenocarcioma with a metastatic ratio of 15.9% (322/2026). Among the patients with upper-thoracic esophageal carcinoma, 9.1% (1/11) of the cases had lymph node metastasis in the superior mediastinum but no lymph node metastasis was found in the middle mediastinum, lower mediastinal and abdominal lymph nodes. The middle-thoracic esophageal adenocarcinoma showed more extensive lymph node metastasis. Lower mediastinal and abdominal lymph node metastases were common in lower-thoracic esophageal cancer. Multivariate analysis showed that gender, length of lesion, depth of invasion and vascular invasion were independent risk factors for lymph node metastasis in esophageal adenocarcinoma (P=0.010, P=0.006, P=0.000, P=0.019, respectively). Male patients had more lymph node metastasis than female patients (49.1% vs 26.3%,P=0.011). The rates of lymph node metastasis in the tumor length ≤3 cm group, 3.1-5 cm group and >5 cm group were 20.4%, 42.9% and 65.7%, respectively. Lymphatic metastasis rates in the T1, T2, T3, T4 stage cancers were 7.1%, 36.8%, 38.1% and 69.4%, respectively, (P<0.001). Patients with vascular invasion had a higher rate of lymph node metastasis (73.9%) than the patients without vascular invasion (41.0%) (P=0.003).
  
  
  CONCLUSIONS
  Most of the esophageal adenocarcinoma are distributed in the middle thoracic esophagus, followed by that in the lower thoracic segment. The lymph node metastasis rate, lymph node metastasis ratio and pattern of lymph node metastasis are similar to those of esophageal squamous cell carcinoma. Male, tumor length, depth of invasion and vascular invasion are risk factors of lymph node metastasis for patients with esophageal adenocarcinoma.
authors.affiliation: Department of Radiation Oncology, Fourth Hospital of Hebei Medical University, Shijiazhuang, 050011, China.
authors.forename: J
authors.initials: J
authors.lastname: Wang
authors.affiliation: Department of Radiation Oncology, Fourth Hospital of Hebei Medical University, Shijiazhuang, 050011, China.
authors.forename: N
authors.initials: N
authors.lastname: Li
authors.affiliation: Department of Radiation Oncology, Fourth Hospital of Hebei Medical University, Shijiazhuang, 050011, China.
authors.forename: X F
authors.initials: XF
authors.lastname: Wang
authors.affiliation: Department of Radiation Oncology, Fourth Hospital of Hebei Medical University, Shijiazhuang, 050011, China.
authors.forename: S W
authors.initials: SW
authors.lastname: Jing
authors.affiliation: Department of Radiation Oncology, Fourth Hospital of Hebei Medical University, Shijiazhuang, 050011, China.
authors.forename: C R
authors.initials: CR
authors.lastname: Yang
authors.affiliation: Department of Radiation Oncology, Fourth Hospital of Hebei Medical University, Shijiazhuang, 050011, China.
authors.forename: Y
authors.initials: Y
authors.lastname: Wang
authors.affiliation: Department of Radiation Oncology, Fourth Hospital of Hebei Medical University, Shijiazhuang, 050011, China.
authors.forename: F
authors.initials: F
authors.lastname: Cao
authors.affiliation: Department of Radiation Oncology, Fourth Hospital of Hebei Medical University, Shijiazhuang, 050011, China.
authors.forename: W P
authors.initials: WP
authors.lastname: Jiao
authors.affiliation: Department of Radiation Oncology, Fourth Hospital of Hebei Medical University, Shijiazhuang, 050011, China.
authors.forename: Y J
authors.initials: YJ
authors.lastname: Wu
authors.affiliation: Department of Radiation Oncology, Fourth Hospital of Hebei Medical University, Shijiazhuang, 050011, China.
authors.forename: Y
authors.initials: Y
authors.lastname: Guo
mesh_terms: D000005:Abdomen / Q000473:pathology; D000230:Adenocarcinoma / Q000556:secondary*; D003528:Carcinoma, Adenoid Cystic / Q000556:secondary*; D018277:Carcinoma, Mucoepidermoid / Q000556:secondary*; D002294:Carcinoma, Squamous Cell / Q000556:secondary*; D004938:Esophageal Neoplasms / Q000473:pathology*; D005260:Female; D006801:Humans; D008197:Lymph Node Excision; D008198:Lymph Nodes / Q000473:pathology*; D008207:Lymphatic Metastasis; D008297:Male; D008482:Mediastinum / Q000473:pathology; D015999:Multivariate Analysis; D012307:Risk Factors; D012737:Sex Factors