Characteristics of lymph node metastasis in thoracic esophageal squamous cell carcinoma: A study of 407 patients_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

CUI Jian , SUN Xiao , SUI Tianyi , LIU Ao ,  JIAO Wenjie

Department of Thoracic Surgery, The Affiliated Hospital of Qingdao University, Qingdao, 266003, Shandong, P.R.China;

Corresponding author：

JIAO Wenjie, Email: jiaowj@qduhospital.cn

Keywords：

Esophageal cancer; esophagectomy; lymph node metastasis; risk factors

DOI：

10.7507/1007-4848.202003151

Video：

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Objective To analyze the characteristics and risk factors of lymph node metastasis in thoracic esophageal squamous cell carcinoma (ESCC).Methods The clinical data of 407 patients with ESCC who underwent radical resection of esophageal carcinoma from December 2012 to October 2018 in our hospital were retrospectively analyzed. There were 390 males and 17 females with a median age of 63 (38-82) years. Esophageal lesions were found in 26 patients of upper thoracic segment, 190 patients of middle thoracic segment and 191 patients of lower thoracic segment. Results Among the patients, 232 (57.0%) were found to have cervical, thoracic and/or abdominal lymph node metastasis. The lymphatic metastasis rates of cervical, upper, middle, lower mediastinal nodes and abdominal nodes were 0.7%, 8.8%, 21.4%, 16.7% and 37.1%, respectively. The adjacent lymph node metastasis alone occurred in 50.0% patients, and the multistage or skip lymph node metastasis accounted for 29.3% and 20.7%, respectively. Multivariate analysis showed that the length of esophageal lesion, T stage, degree of tumor differentiation, vascular cancer embolus and nerve invasion were independent risk factors for lymph node metastasis.Conclusion The rates of lymph node metastasis are similar in the upper, middle and lower thoracic ESCC. The main pattern of lymph node metastasis is the adjacent lymph node metastasis, followed by multistage and skip lymph node metastases. The length of esophageal lesion, T stage, degree of tumor differentiation, vascular cancer embolus and nerve invasion are independent factors for lymph node metastasis. The operation and dissection range should be selected according to the location of tumor and the characteristics of the lesion.

Citation： CUI Jian, SUN Xiao, SUI Tianyi, LIU Ao, JIAO Wenjie. Characteristics of lymph node metastasis in thoracic esophageal squamous cell carcinoma: A study of 407 patients. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2020, 27(9): 1063-1069. doi: 10.7507/1007-4848.202003151 Copy

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8.	段晓峰, 尚晓滨, 唐鹏, 等. T1期食管癌淋巴结转移的预后因素分析. 中华外科杂志, 2017, 55(9): 690-695.
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11.	Samson P, Puri V, Broderick S, <italic>et al</italic>. Extent of lymphadenectomy is associated with improved overall survival after esophagectomy with or without induction therapy. Ann Thorac Surg, 2017, 103(2): 406-415.
12.	Park SY, Kim DJ, Do YW, <italic>et al</italic>. The oncologic outcome of esophageal squamous cell carcinoma patients after robot-assisted thoracoscopic esophagectomy with total mediastinal lymphaden-ectomy. Ann Thorac Surg, 2017, 103(4): 1151-1157.
13.	Shang QX, Yang YS, Hu WP, <italic>et al</italic>. Prognostic significance and role of thoracic lymph node metastasis based on Chinese expert consensus in esophageal cancer. Ann Transl Med, 2019, 7(16): 381.
14.	Wu H, Liu C, Xu M, <italic>et al</italic>. Prognostic value of the number of negative lymph nodes in esophageal carcinoma without lymphatic metastasis. Thorac Cancer, 2018, 9(9): 1129-1135.
15.	Matsuda S, Takeuchi H, Kawakubo H, <italic>et al</italic>. Three-field lymph node dissection in esophageal cancer surgery. J Thorac Dis, 2017, 9(Suppl 8): S731-S740.
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17.	张泉, 吴清泉, 常新, 等. 胸中段食管鳞癌左胸路径根治性手术后局部区域复发规律的研究. 中华放射医学与防护杂志, 2017, 37(9): 661-666.
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19.	柳硕岩, 王镇, 王枫. 胸段食管癌三野与二野加淋巴结清扫的选择. 中华胃肠外科杂志, 2016, 19(9): 975-978.
20.	Koterazawa Y, Oshikiri T, Takiguchi G, <italic>et al</italic>. Prophylactic cervical lymph node dissection in thoracoscopic esophagectomy for esophageal cancer increases postoperative complications and does not improve survival. Ann Surg Oncol, 2019, 26(9): 2899-2904.
21.	李振轩, 王瑞琦, 杨弘, 等. 胸段食管鳞癌上纵隔淋巴结转移规律探讨. 中华胸心血管外科杂志, 2016, 32(2): 113-114, 122.
22.	Li B, Chen H, Xiang J, <italic>et al</italic>. Pattern of lymphatic spread in thoracic esophageal squamous cell carcinoma: A single-institution experience. J Thorac Cardiovasc Surg, 2012, 144(4): 778-786.
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24.	Haisley KR, Hart KD, Fischer LE, <italic>et al</italic>. Increasing tumor length is associated with regional lymph node metastases and decreased survival in esophageal cancer. Am J Surg, 2016, 211(5): 860-866.
25.	代磊, 任自学, 张安庆, 等. 177例胸段食管癌淋巴结转移规律研究. 中国胸心血管外科临床杂志, 2017, 24(2): 122-126.
26.	王军, 韩春, 祝淑钗, 等. 胸段食管癌淋巴结转移规律及其影响因素. 中国肿瘤临床, 2010, 37(2): 90-93.
27.	郭睿, 杨勇伟, 金澄宇, 等. 食管癌淋巴结转移的危险因素分析. 中华胃食管反流病电子杂志, 2018, 5(1): 7-9.
28.	高凯, 石佳, 张春敭, 等. 食管癌淋巴结转移危险因素分析. 中华临床医师杂志(电子版), 2018, 12(11): 605-608.

1. 左婷婷, 郑荣寿, 曾红梅, 等. 中国食管癌发病状况与趋势分析. 中华肿瘤杂志, 2016, 38(9): 703-708.
2. Japan Esophageal Society. Japanese Classification of Esophageal Cancer, 11th Edition: part Ⅱ and Ⅲ. Esophagus, 2017, 14: 37-65.
3. Chen JQ, Liu SY, Pan JJ, <italic>et al</italic>. The pattern and prevalence of lymphatic spread in thoracic oesophageal squamous cell carcinoma. Eur J Cardiothorac Surg, 2009, 36: 480-486.
4. Arnold M, Soerjomataram I, Ferlay J, <italic>et al</italic>. Global incidence of oesophageal cancer by histological subtype in 2012. Gut, 2015, 64: 381-387.
5. Bray F, Ferlay J, Soerjomataram I, Siegel RL, <italic>et al</italic>. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin, 2018, 68(6): 394-424.
6. 陈元美, 陈俊强, 朱坤寿, 等. 淋巴结转移数目与胸段食管鳞癌根治术预后关系. 中华胸心血管外科杂志, 2014, 30(2): 76-78.
7. 张合林, 何明, 孟宪利, 等. 1146例胸段食管癌淋巴结转移的相关因素. 中国肿瘤临床, 2007, 34(11): 650-652, 660.
8. 段晓峰, 尚晓滨, 唐鹏, 等. T1期食管癌淋巴结转移的预后因素分析. 中华外科杂志, 2017, 55(9): 690-695.
9. Zhu Z, Yu W, Li H, <italic>et al</italic>. Nodal skip metastasis is not a predictor of survival in thoracic esophageal squamous cell carcinoma. Ann Surg Oncol, 2013, 20(9): 3052-3058.
10. Prenzel KL, Bollschweiler E, Schröder W, <italic>et al</italic>. Prognostic relevance of skip metastases in esophageal cancer. Ann Thorac Surg, 2010, 90(5): 1662-1667.
11. Samson P, Puri V, Broderick S, <italic>et al</italic>. Extent of lymphadenectomy is associated with improved overall survival after esophagectomy with or without induction therapy. Ann Thorac Surg, 2017, 103(2): 406-415.
12. Park SY, Kim DJ, Do YW, <italic>et al</italic>. The oncologic outcome of esophageal squamous cell carcinoma patients after robot-assisted thoracoscopic esophagectomy with total mediastinal lymphaden-ectomy. Ann Thorac Surg, 2017, 103(4): 1151-1157.
13. Shang QX, Yang YS, Hu WP, <italic>et al</italic>. Prognostic significance and role of thoracic lymph node metastasis based on Chinese expert consensus in esophageal cancer. Ann Transl Med, 2019, 7(16): 381.
14. Wu H, Liu C, Xu M, <italic>et al</italic>. Prognostic value of the number of negative lymph nodes in esophageal carcinoma without lymphatic metastasis. Thorac Cancer, 2018, 9(9): 1129-1135.
15. Matsuda S, Takeuchi H, Kawakubo H, <italic>et al</italic>. Three-field lymph node dissection in esophageal cancer surgery. J Thorac Dis, 2017, 9(Suppl 8): S731-S740.
16. 邵明雯, 蒋雯, 陈亮, 等. 食管癌淋巴结转移特点分析. 现代肿瘤医学, 2019, 27(22): 4005-4009.
17. 张泉, 吴清泉, 常新, 等. 胸中段食管鳞癌左胸路径根治性手术后局部区域复发规律的研究. 中华放射医学与防护杂志, 2017, 37(9): 661-666.
18. Xu J, Zheng B, Zhang S, <italic>et al</italic>. The clinical significance of the intraoperative pathological examination of bilateral recurrent laryngeal nerve lymph nodes using frozen sections in cervical field lymph node dissection of thoracic esophageal squamous cell carcinoma. J Thorac Dis, 2019, 11(8): 3525-3533.
19. 柳硕岩, 王镇, 王枫. 胸段食管癌三野与二野加淋巴结清扫的选择. 中华胃肠外科杂志, 2016, 19(9): 975-978.
20. Koterazawa Y, Oshikiri T, Takiguchi G, <italic>et al</italic>. Prophylactic cervical lymph node dissection in thoracoscopic esophagectomy for esophageal cancer increases postoperative complications and does not improve survival. Ann Surg Oncol, 2019, 26(9): 2899-2904.
21. 李振轩, 王瑞琦, 杨弘, 等. 胸段食管鳞癌上纵隔淋巴结转移规律探讨. 中华胸心血管外科杂志, 2016, 32(2): 113-114, 122.
22. Li B, Chen H, Xiang J, <italic>et al</italic>. Pattern of lymphatic spread in thoracic esophageal squamous cell carcinoma: A single-institution experience. J Thorac Cardiovasc Surg, 2012, 144(4): 778-786.
23. Kunisaki C, Makino H, Kimura J, <italic>et al</italic>. Impact of lymph-node metastasis site in patients with thoracic esophageal cancer. J Surg Oncol, 2010, 101(1): 36-42.
24. Haisley KR, Hart KD, Fischer LE, <italic>et al</italic>. Increasing tumor length is associated with regional lymph node metastases and decreased survival in esophageal cancer. Am J Surg, 2016, 211(5): 860-866.
25. 代磊, 任自学, 张安庆, 等. 177例胸段食管癌淋巴结转移规律研究. 中国胸心血管外科临床杂志, 2017, 24(2): 122-126.
26. 王军, 韩春, 祝淑钗, 等. 胸段食管癌淋巴结转移规律及其影响因素. 中国肿瘤临床, 2010, 37(2): 90-93.
27. 郭睿, 杨勇伟, 金澄宇, 等. 食管癌淋巴结转移的危险因素分析. 中华胃食管反流病电子杂志, 2018, 5(1): 7-9.
28. 高凯, 石佳, 张春敭, 等. 食管癌淋巴结转移危险因素分析. 中华临床医师杂志(电子版), 2018, 12(11): 605-608.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Characteristics of lymph node metastasis in thoracic esophageal squamous cell carcinoma: A study of 407 patients

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