Analysis of Lymph Node Metastases of 1,526 Cases with Thoracic Esophageal and Cardiac Carcinomas: A Random Sampling Report from the Fourth Hospital of Hebei Medical University from 1996 to 2004

Wei LIU, Xishan HAO, Yong CHEN, Haixin LI, Shijie WANG, Peizhong WANG, Ying JIN, Liyun GUAN, Qian FAN, Linan SONG, Yumin PING, Xianli MENG, Rui WANG, Junfeng LIU, Xiaoling WANG

Abstract


OBJECTIVE     To summarize the regular pattern and state of lymph node metastasis of patients with esophageal and cardiac carcinomas, so as to analyze factors influencing lymph node metastasis.
METHODS    Clinical data collected from 1,526 thoracic esophageal and cardiac carcinoma patients who were admitted in the Fourth Hospital of Hebei Medical University during a period from January 1996 to December 2004, were randomly selected and an Access Database of the patient’s information was set up. Eight clinico-pathologic factors,including the patient’s age, tumor location and size, pathological classification, the depth of tumor invasion, vascular tumor embolus (VTE), the state of surrounding  organ encroachment and the status of tumor residues, were identified. A correlation between these factors and metastases was statistically analyzed using SPSS13.0 software.
RESULTS     Lymph node metastatic sites from esophageal carcinomas included the thoracic and abdominal cavity.Lymph node metastasis from the superior esophageal carcinomas mainly occurred in the neck and thoracic cavity. There was a two-way lymph node metastasis in the patients with the middle esophageal carcinoma. The inferior esophageal carcinomas mainly metastasized to the paraesophageal, paragastric cardia, and left gastric artery lymph nodes. The rate and degree of the metastasis from the inferior esophageal carcinomas were signi fi cantly higher compared to those of the superior and the middle esophageal carcinomas ( P < 0.0125).
    The degree of abdominal lymph node metastasis from carcinomas of the gastric cardia was signifi cantly higher compared with that of esophageal carcinomas. In the group with carcinoma of the gastric cardia, the rate and degree of the lymph node metastases in the paragastric cardia and left gastric artery were significantly higher compared to the group with esophageal carcinoma (P < 0.05). Paraesophageal lymph node metastasis from carcinomas of the gastric cardia in the thoracic cavity frequently occurred, too, and the degree of the metastasis was similar to that of esophageal carcinoma. There was no significant difference in the rate and degree of the paraesophageal lymph-node metastasis between the group with carcinoma of the gastric cardia compared to those with esophageal carcinoma (P  > 0.05). Multifactorial logistic regression analysis showed that the tumor size, depth of tumor encroachment, VTE, and tumor residues could all bring about obvious impact on lymph-node metastases (P < 0.05).
CONCLUSION     Lymph node metastasis from superior esophageal carcinomas mainly occurs in the neck and thoracic cavity. The middle esophageal carcinomas presented a two-way lymph-node metastasis (both the upwards and the downwards), and the lymph node metastasis from inferior esophageal carcinomas mainly occurred in the thoracic and abdominal cavities. The metastases of carcinoma of the gastric cardia were most commonly found in the abdominal cavity, with frequent paraesophageal lymph-node  metastasis. The sufficient attention should be paid to neck lymph node clearance in cases of esophageal carcinoma. What is of the greatest concern is the clearance of the left  gastric artery lymph nodes, and also in cases of gastric cardia carcinoma, clearance, the paraesophageal lymph nodes. With an increase in the tumor size and depth of tumor encroachment, and occurrence of VTE and tumor residual cells, the risk of lymph node metastasis is signi fi cantly raised ( P < 0.05). 


Keywords


esophageal carcinoma, cardiac carcinoma, lymph node metastasis, Logistic regression model.

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