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ANALYSIS OF RISK FACTORS OF LYMPH NODE METASTASIS OF SUPERFICIAL ESOPHAGEAL CANCE
xiaoran shen*, Yini Dang, Guoxin Zhang
Department of Gastroenterology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China, Nanjing, China
Background: Endoscopic treatments are gradually considered as a reliable treatment of superficial esophageal carcinoma. Compared with surgical treatment, endoscopic resection (ER) can keep the esophagus, reduce the associated postoperative complications, and have low mortality. However, endoscopic resection (ER) is limited by the potential lymph node metastasis (LNM).
Methods: We conducted a retrospective review of 769 patients with pT1 superficial esophageal carcinoma who underwent surgical resection from January 2010 to December 2016. The clinical characteristics and pathological features including gender, age, smoking, drinking,tumor location, size, histological type, differentiation, invasion depth, vascular invasion and nodal status were analyzed.
Results: The rate of lymph node metastasis in superficial esophageal cancer was 15.34%. Alcohol, tumor size, histological type, differentiation, depth of invasion, Angiolymhatic invasion were correlated with lymph node metastasis. Multivariate analysis showed that only tumor size, differentiation, depth of invasion and vascular invasion were independent risk factors for superficial esophageal cancer. The accuracy of preoperative lymph node metastasis assessment,histological evaluation and ultrasound endoscopy in evaluating depth of invasion was 58.9%, 51.1%, and 32.7% respectively.
Conclusions: The size of tumor, the degree of differentiation, the depth of invasion and the presence or absence of vascular infiltration are independent risk factors for superficial esophageal cancer. For patients with tumors less than 2 cm, high degree of differentiation, located in the mucosal layer, without vascular metastasis,ER is considered as a reliable treatment. Otherwise, surgical treatment of Lymphadenectomy. Meanwhile, it is crucial of accurate preoperative assessment of the lymph node status and risk factors for superficial esophageal cancer.
Univariate and multivariate analysis of histopathological predictors of lymph node metastases
| Variables | Univariate analysis | Multivariate analysis | | OR(95%CI） | P | OR(95%CI） | P | | Age | 1.04(0.68-1.58) | 0.87 | | | | Gender | 1.49(0.87-2.56) | 0.15 | | | | Smoking | 0.88(0.51-1.51) | 0.63 | | | | Drinking | 1.88(1.08-3.28) | 0.03 | | | | Basic diseases | 1.07(0.68-1.68) | 0.77 | | | | Family history of cancer | 0.89(0.47-1.67) | 0.71 | | | | TAP | 2.97(0.94-9.39) | 0.06 | | | | Tumor size | 2.18(1.42-3.35) | 0.00 | 1.83（1.15-2.92） | 0.01 | | Tumor location | 1.19(0.99-1.41) | 0.053 | | | | Histological type | 1.61(1.18-2.20) | 0.003 | | | | Differentiation | 2.37(1.61-3.50) | 0.00 | 1.65（1.18-2.31） | 0.003 | | Pathological type | 1.02(0.83-1.25) | 0.86 | | | | Depth of invasion | 5.95(3.13-11.28) | 0.00 | 2.13（1.00-4.53） | 0.049 | | Angiolymhatic invasion | 7.83(4.24-14.47) | 0.00 | 5.75（2.97-11.10） | 0.00 |
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