RT Journal Article
SR Electronic
T1 Pattern of Lymphatic Metastasis and Influencing Factors in Thoracic Esophageal Carcinoma
JF Clinical Oncology and Cancer Research
JO Cancer Biol Med
FD China Anti-Cancer Association
SP 342
OP 346
DO 10.1007/s11805-009-0342-1
VO 6
IS 5
A1 Jun Wang
A1 Chun Han
A1 Shuchai Zhu
A1 Chao Gao
A1 Xiaoning Li
YR 2009
UL http://www.cancerbiomed.org/content/6/5/342.abstract
AB OBJECTIVE To explore the regular patterns of lymphatic metastasis in thoracic esophageal carcinoma (TEC) and the factors influencing these patt erns.METHODS Data of 229 TEC patients who underwent radical esophagectomy and thoracoabdominal 2-field lymphadenectomy were reviewed. Within this patient population, a total of 2458 lymph nodes were dissected during surgery. The distribution of the nodular metastasis rates (NMR) in various diseased regions in the esophageal carcinoma (EC) patients as well as factors influencing metastases such as the depth of tumor infiltration, tumor size, tumor morphology, and degree of tumor differentiation were analyzed.RESULTS i) Lymphatic metastasis (LM) occurred in 102 EC cases, and the lymphatic metastasis rate (LMR) was 44.5% (102/229). The NMR was 9.5% (258/2458). ii) The NMRs were 19.0%, 6.7%, 9.8% and 12.2% in the superior, middle and inferior mediastinum, and abdominal cavity, respectively, in patients with EC in the superior thoracic segment; 26.1%, 7.4%, 11.8% and 11.9% in the same sites of the mediastinum, respectively, in those with middle thoracic-segment EC; and 0%, 1.6%, 5.3%, and 10.0%, respectively, in the same sites in those with inferior thoracic EC. iii) The LMRs of the EC patients in stage-T1, T2, T3 and T4 were 28.6%, 43.8%, 47.6% and 31.3%, respectively, and the NMRs of the patients were 7.9%, 10.8%, 10.7% and 10.8%, respectively. There were no significant differences between the LMR and the NMR of the EC patients in stage T1 to T4 (χ2 = 2.733, P = 0.435 and χ2 = 0.686, P = 0.876). iv) The LMR of the patients with the length of tumor ≤ 3 cm, > 3 cm and ≤ 5 cm, and > 5 cm were 45.2%, 43.4% and 46.2%, respectively, and the NMR according to the same range of the tumor size above were 9.1%, 11.6% and 11.7%, respectively. There were no significant differences between the groups (χ2 = 0.094, P = 0.954 and χ2 = 3.933, P = 0.140). v) The NMRs of the medullary, ulcerative, fungoid and sclerotic-type EC were 14.0%, 9.6%, 4.3% and 18.3%, respectively (χ2 = 19.292, P = 0.000), among which the NMR of the fungoid-type EC was the lowest. The LMRs were 42.5% and 75.0%, respectively in the cases with squamous cell carcinoma (SqCC) and poorly differentiated SqCC (χ2 = 4.852, P = 0.028), and the NMRs were 9.5% and 18.6% correspondingly in the 2 groups (χ2 = 11.323, P = 0.001). LM was commonly seen in the cases with poorly differentiated tumors.CONCLUSION Lymph node metastases of TEC spreads widely and can involve many regions. Metastasis can even be found in early stages of EC. Morphologic type and the degree of tumor differentiation are the main factors affecting the LM.