Abstract
Objective:To analyze the correlation between lymph node metastasis of thoracic esophageal squamous cell carcinoma (ESCC) and clinical and pathological factors, and to provide a reference for the outline of clinical target volume.Methods:The pathological characteristics of 1034 thoracic ESCC patients after surgery were described, and the correlations between clinical and pathological factors and lymph node metastasis were studied by univariate and Logistic multivariate analyses.Results:Lymph node metastasis was significantly correlated with tumor length, invasion depth and differentiation degree (P<0.01), but not gender, age, tumor site or pathological type (P>0.05). Logistic multivariate analysis showed that tumor length, invasion depth and differentiation degree were independent risk factors for thoracic ESCC. The lymph node metastasis rates of mid-thoracic ESCC in the middle mediastinum, lower-thoracic ESCC in the lower mediastinum and abdominal cavity were 18.5%, 35.3% and 19.7% respectively in the T1-T2 stage. In the T3-T4 stage, the lymph node metastasis rates of mid-thoracic ESCC in the middle mediastinum and abdominal cavity were 39.6% and 17.4% respectively, and those of lower-thoracic ESCC in middle and lower mediastina and abdominal cavity were 21.1%, 43.4% and 29.8% respectively. Highly/moderately differentiated mid-thoracic ESCC in the middle mediastinum, lower-thoracic ESCC in middle and lower mediastina and abdominal cavity had the lymph node metastasis rates of 34.7%, 15.1%, 33.5% and 23.7% respectively. Lowly differentiated mid-thoracic ESCC in the middle mediastinum and abdominal cavity had the lymph node metastasis rates of 46.9% a 29.6% respectively, and those of lower-thoracic ESCC in middle and lower mediastina and abdominal cavity were 25.5%, 49.1% and 27.3% respectively.Conclusion:During the outline of radiotherapy target volume for thoracic ESCC, tumor length, invasion depth and differentiation degree should be comprehensively considered to selectively irradiate the regions prone to lymph node metastasis.
Highlights
Esophageal cancer prevails in China, with the morbidity and morbidity rates ranking fourth among those of all malignant tumors.[1]
Lymph node metastasis was significantly correlated with tumor length (χ2 = 22.314, P
Logistic multivariate analysis showed that tumor length, invasion depth and differentiation degree were independent risk factors for thoracic esophageal squamous cell carcinoma (ESCC) metastasis (Table-II)
Summary
Esophageal cancer prevails in China, with the morbidity and morbidity rates ranking fourth among those of all malignant tumors.[1]. The state of lymph node affects TNM stage, design of treatment regimen and evaluation of prognosis.[4] On one hand, the radiotherapy for esophageal cancer is used to improve the dose distribution of tissues with pathological changes and peripheral normal ones together with organs at risk by using physical means, thereby increasing the local control rate. The radiotherapy target volume can be accurately regulated.[5] The therapeutic effects of 3D-CRT and routine radiotherapy have been compared.[6,7] The former is markedly superior to the latter in the dose distribution of target volume and the risk to peripheral normal tissues. 3D-CRT manages to overcome the disadvantages induced by large T-shaped field of postoperative prophylactic radiotherapy, such as high tumor residual rate because of unsatisfactory dose distribution The therapeutic effects of 3D-CRT and routine radiotherapy have been compared.[6,7] The former is markedly superior to the latter in the dose distribution of target volume and the risk to peripheral normal tissues. 3D-CRT manages to overcome the disadvantages induced by large T-shaped field of postoperative prophylactic radiotherapy, such as high tumor residual rate because of unsatisfactory dose distribution
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