Analysis of risk factors for lymph node metastasis and prognosis in T1-stage esophageal squamous cell carcinoma_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

FEI Xiang , WANG Xinyu , LU Qijue , LI Chunguang , YANG Lixin , CHEN Hezhong ,  LU Chaojing

Department of Thoracic Surgery, Changhai Hospital, Naval Military Medical University, Shanghai, 200433, P.R.China;

Corresponding author：

LU Chaojing, Email: luchaojing@126.com

Keywords：

T1-stage esophageal squamous carcinoma; lymph node metastasis; prognosis; risk factor; surgery

DOI：

10.7507/1007-4848.201910059

Video：

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Objective To investigate the risk factors for lymph node metastasis (LNM) and prognosis of T1-stage esophageal squamous carcinoma (ESC).Methods Clinical data of 387 patients with T1-stage ESC who underwent surgical treatment in our hospital from March 2013 to March 2018 were collected. There were 281 males and 106 females aged 60 (41-80) years. The patients were divided into a lymph node metastasis group (n=77) and a non-metastasis group (n=310). The risk factors for LNM and prognosis were analyzed.Results Among 387 patients with T1-stage ESC, 77 (19.9%) patients had LNM. The incidence of LNM was 8.4% (8/95) in T1a-stage patients and 23.6% (69/292) in T1b-stage patients. Univariate analysis showed that tumor size, differentiation degree, depth of invasion and vascular tumor thrombus were associated with LNM (P<0.05). Multivariate logistic regression analysis showed that invasion depth of tumor [OR=2.456, 95%CI (1.104, 5.463), P<0.05] and vascular tumor thrombus [OR=15.766, 95%CI (4.880, 50.938), P<0.05] were independent risk factors for LNM. The follow-up time was 41 (12, 66) months. The 1-year, 3-year and 5-year survival rates were 98.71%, 89.67% and 86.82%, respectively. Univariate analysis showed statistically significant differences in tumor invasion depth, vascular tumor thrombus and LNM between the survival group and the death group. Cox analysis showed that LNM [OR=3.794, 95%CI (2.109, 6.824), P<0.05] was an independent risk factor for prognosis.Conclusion T1-stage ESC patients with deeper invasion or vascular tumor thrombus have a higher risk of LNM. The prognosis of T1-stage ESC with LNM is relatively poor.

Citation： FEI Xiang, WANG Xinyu, LU Qijue, LI Chunguang, YANG Lixin, CHEN Hezhong, LU Chaojing. Analysis of risk factors for lymph node metastasis and prognosis in T1-stage esophageal squamous cell carcinoma. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2020, 27(6): 657-662. doi: 10.7507/1007-4848.201910059 Copy

1.	Ell C, May A, Pech O, et al. Curative endoscopic resection of early esophageal adenocarcinomas (Barrett's cancer). Gastrointest Endosc, 2007, 65(1): 3-10.
2.	Mönig S, Chevallay M, Niclauss N, et al. Early esophageal cancer: the significance of surgery, endoscopy, and chemoradiation. Ann N Y Acad Sci, 2018, 1434(1): 115-123.
3.	Emi M, Hihara J, Hamai Y, et al. Clinicopathologic features of submucosal esophageal squamous cell carcinoma. Ann Thorac Surg, 2017, 104(6): 1858-1864.
4.	Zhou Y, Du J, Li H, et al. Clinicopathologic analysis of lymph node status in superficial esophageal squamous carcinoma. World J Surg Oncol, 2016, 14(1): 259.
5.	Molena D, Schlottmann F, Boys JA, et al. Esophagectomy following endoscopic resection of submucosal esophageal cancer: a highly curative procedure even with nodal metastases. J Gastrointest Surg, 2017, 21(1): 62-67.
6.	Goseki N, Koike M, Yoshida M. Histopathologic characteristics of early stage esophageal carcinoma. A comparative study with gastric carcinoma. Cancer, 1992, 69(5): 1088-1093.
7.	Ando N, Ozawa S, Kitagawa Y, et al. Improvement in the results of surgical treatment of advanced squamous esophageal carcinoma during 15 consecutive years. Ann Surg, 2000, 232(2): 225-232.
8.	Park SY, Kim DJ, Son T, et al. Extent of mediastinal lymphadenectomy and survival in superficial esophageal squamous cell carcinoma. J Gastrointest Surg, 2017, 21(10): 1584-1590.
9.	Kajiyama Y, Iwanuma Y, Tomita N, et al. Size analysis of lymph node metastasis in esophageal cancer: diameter distribution and assessment of accuracy of preoperative diagnosis. Esophagus, 2006, 3(4): 189-195.
10.	Park SY, Kim DJ, Jung HS, et al. Relationship between the size of metastatic lymph nodes and positron emission tomographic/computer tomographic findings in patients with esophageal squamous cell carcinoma. World J Surg, 2015, 39(12): 2948-2954.
11.	Shen W, Shen Y, Tan L, et al. A nomogram for predicting lymph node metastasis in surgically resected T1 esophageal squamous cell carcinoma. J Thorac Dis, 2018, 10(7): 4178-4185.
12.	Yajin S, Murakami G, Takeuchi H, et al. The normal configuration and interindividual differences in intramural lymphatic vessels of the esophagus. J Thorac Cardiovasc Surg, 2009, 137(6): 1406-1414.
13.	Tomita N, Matsumoto T, Hayashi T, et al. Lymphatic invasion according to D2-40 immunostaining is a strong predictor of nodal metastasis in superficial squamous cell carcinoma of the esophagus: algorithm for risk of nodal metastasis based on lymphatic invasion. Pathol Int, 2008, 58(5): 282-287.
14.	杨玉赏, 胡伟鹏, 陈龙奇. 脉管癌栓对食管鳞状细胞癌预后的影响. 中华胸心血管外科杂志, 2015, 31(11): 656-659.
15.	李苗, 曾晓清, 谭黎杰, 等. 浅表食管癌术后患者的生存及预后分析. 中华医学杂志, 2016, 96(6): 460-463.
16.	Li B, Chen H, Xiang J, et al. Prevalence of lymph node metastases in superficial esophageal squamous cell carcinoma. J Thorac Cardiovasc Surg, 2013, 146(5): 1198-1203.
17.	Pennathur A, Farkas A, Krasinskas AM, et al. Esophagectomy for T1 esophageal cancer: outcomes in 100 patients and implications for endoscopic therapy. Ann Thorac Surg, 2009, 87(4): 1048-1054.
18.	Hölscher AH, Bollschweiler E, Schröder W, et al. Prognostic impact of upper, middle, and lower third mucosal or submucosal infiltration in early esophageal cancer. Ann Surg, 2011, 254(5): 802-807.
19.	Tanaka T, Matono S, Nagano T, et al. Esophagectomy with extended lymphadenectomy for submucosal esophageal cancer: long-term outcomes and prognostic factors. Ann Surg Oncol, 2012, 19(3): 750-756.
20.	Kato H, Tachimori Y, Watanabe H, et al. Superficial esophageal carcinoma. Surgical treatment and the results. Cancer, 1990, 66(11): 2319-2323.
21.	Nabeya K, Nakata Y. Extent of resection and lymphadenectomy in early squamous cell esophageal cancer. Dis Esophagus, 1997, 10(3): 159-161.

1. Ell C, May A, Pech O, et al. Curative endoscopic resection of early esophageal adenocarcinomas (Barrett's cancer). Gastrointest Endosc, 2007, 65(1): 3-10.
2. Mönig S, Chevallay M, Niclauss N, et al. Early esophageal cancer: the significance of surgery, endoscopy, and chemoradiation. Ann N Y Acad Sci, 2018, 1434(1): 115-123.
3. Emi M, Hihara J, Hamai Y, et al. Clinicopathologic features of submucosal esophageal squamous cell carcinoma. Ann Thorac Surg, 2017, 104(6): 1858-1864.
4. Zhou Y, Du J, Li H, et al. Clinicopathologic analysis of lymph node status in superficial esophageal squamous carcinoma. World J Surg Oncol, 2016, 14(1): 259.
5. Molena D, Schlottmann F, Boys JA, et al. Esophagectomy following endoscopic resection of submucosal esophageal cancer: a highly curative procedure even with nodal metastases. J Gastrointest Surg, 2017, 21(1): 62-67.
6. Goseki N, Koike M, Yoshida M. Histopathologic characteristics of early stage esophageal carcinoma. A comparative study with gastric carcinoma. Cancer, 1992, 69(5): 1088-1093.
7. Ando N, Ozawa S, Kitagawa Y, et al. Improvement in the results of surgical treatment of advanced squamous esophageal carcinoma during 15 consecutive years. Ann Surg, 2000, 232(2): 225-232.
8. Park SY, Kim DJ, Son T, et al. Extent of mediastinal lymphadenectomy and survival in superficial esophageal squamous cell carcinoma. J Gastrointest Surg, 2017, 21(10): 1584-1590.
9. Kajiyama Y, Iwanuma Y, Tomita N, et al. Size analysis of lymph node metastasis in esophageal cancer: diameter distribution and assessment of accuracy of preoperative diagnosis. Esophagus, 2006, 3(4): 189-195.
10. Park SY, Kim DJ, Jung HS, et al. Relationship between the size of metastatic lymph nodes and positron emission tomographic/computer tomographic findings in patients with esophageal squamous cell carcinoma. World J Surg, 2015, 39(12): 2948-2954.
11. Shen W, Shen Y, Tan L, et al. A nomogram for predicting lymph node metastasis in surgically resected T1 esophageal squamous cell carcinoma. J Thorac Dis, 2018, 10(7): 4178-4185.
12. Yajin S, Murakami G, Takeuchi H, et al. The normal configuration and interindividual differences in intramural lymphatic vessels of the esophagus. J Thorac Cardiovasc Surg, 2009, 137(6): 1406-1414.
13. Tomita N, Matsumoto T, Hayashi T, et al. Lymphatic invasion according to D2-40 immunostaining is a strong predictor of nodal metastasis in superficial squamous cell carcinoma of the esophagus: algorithm for risk of nodal metastasis based on lymphatic invasion. Pathol Int, 2008, 58(5): 282-287.
14. 杨玉赏, 胡伟鹏, 陈龙奇. 脉管癌栓对食管鳞状细胞癌预后的影响. 中华胸心血管外科杂志, 2015, 31(11): 656-659.
15. 李苗, 曾晓清, 谭黎杰, 等. 浅表食管癌术后患者的生存及预后分析. 中华医学杂志, 2016, 96(6): 460-463.
16. Li B, Chen H, Xiang J, et al. Prevalence of lymph node metastases in superficial esophageal squamous cell carcinoma. J Thorac Cardiovasc Surg, 2013, 146(5): 1198-1203.
17. Pennathur A, Farkas A, Krasinskas AM, et al. Esophagectomy for T1 esophageal cancer: outcomes in 100 patients and implications for endoscopic therapy. Ann Thorac Surg, 2009, 87(4): 1048-1054.
18. Hölscher AH, Bollschweiler E, Schröder W, et al. Prognostic impact of upper, middle, and lower third mucosal or submucosal infiltration in early esophageal cancer. Ann Surg, 2011, 254(5): 802-807.
19. Tanaka T, Matono S, Nagano T, et al. Esophagectomy with extended lymphadenectomy for submucosal esophageal cancer: long-term outcomes and prognostic factors. Ann Surg Oncol, 2012, 19(3): 750-756.
20. Kato H, Tachimori Y, Watanabe H, et al. Superficial esophageal carcinoma. Surgical treatment and the results. Cancer, 1990, 66(11): 2319-2323.
21. Nabeya K, Nakata Y. Extent of resection and lymphadenectomy in early squamous cell esophageal cancer. Dis Esophagus, 1997, 10(3): 159-161.

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Analysis of risk factors for lymph node metastasis and prognosis in T1-stage esophageal squamous cell carcinoma

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