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Prevalence of lymph node metastases in superficial esophageal squamous cell carcinoma.
J Thorac Cardiovasc Surg 2013; 146(5):1198-203JT

Abstract

OBJECTIVE

Endoscopic treatment of superficial esophageal carcinoma has been increasingly conducted around the world. Because no lymph nodes are removed in such a procedure, the risk of lymph node metastases (LNMs) should be clearly understood. The aim of the present study was to accurately clarify the pattern of lymphatic spread in patients with superficial esophageal squamous cell carcinoma and analyze the factors potentially related to LNMs.

METHODS

The pattern of lymphatic spread was studied in 189 patients who had undergone radical lymphadenectomy from 2006 to 2011. The risk factors associated with LNMs were determined by multivariate logistic regression analysis. According to the depth of tumor invasion, mucosal tumors were classified as M1, M2, and M3 and submucosal tumors as SM1, SM2, and SM3.

RESULTS

A total of 4252 lymph nodes were resected (average, 23 ± 9; range, 12-68). LNMs occurred in 49 patients (25.9%). The frequency of LNMs was 4.3% in those with mucosal and 33.1% in those with submucosal cancer. LNMs were found in 0%, 0%, 11.8%, 24.0%, 20.5%, and 43.8% of the M1, M2, M3, SM1, SM2, and SM3 cancer, respectively. For submucosal cancer, SM3 cancer (P = .006) and lymphovascular invasion (P = .001) were significant independent risk factors for LNMs. Paratracheal nodes were the most frequently involved. "Skip" metastases occurred in 20 of 49 patients (40.8%).

CONCLUSIONS

Endoscopic treatment can be attempted when the tumor is limited to the lamina propria mucosa. However, 2-field radical lymphadenectomy with careful upper mediastinal lymph node resection should be conducted for submucosal squamous cell carcinoma.

Authors+Show Affiliations

Department of Thoracic Surgery, Fudan University Shanghai Cancer Center, Shangai, China; Department of Oncology, Shanghai Medical College, Fudan University, Shangai, China.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

23988285

Citation

Li, Bin, et al. "Prevalence of Lymph Node Metastases in Superficial Esophageal Squamous Cell Carcinoma." The Journal of Thoracic and Cardiovascular Surgery, vol. 146, no. 5, 2013, pp. 1198-203.
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):1198-203.
Li, B., Chen, H., Xiang, J., Zhang, Y., Kong, Y., Garfield, D. H., & Li, H. (2013). Prevalence of lymph node metastases in superficial esophageal squamous cell carcinoma. The Journal of Thoracic and Cardiovascular Surgery, 146(5), pp. 1198-203. doi:10.1016/j.jtcvs.2013.07.006.
Li B, et al. Prevalence of Lymph Node Metastases in Superficial Esophageal Squamous Cell Carcinoma. J Thorac Cardiovasc Surg. 2013;146(5):1198-203. PubMed PMID: 23988285.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Prevalence of lymph node metastases in superficial esophageal squamous cell carcinoma. AU - Li,Bin, AU - Chen,Haiquan, AU - Xiang,Jiaqing, AU - Zhang,Yawei, AU - Kong,Yunyi, AU - Garfield,David H, AU - Li,Hecheng, Y1 - 2013/08/26/ PY - 2013/02/22/received PY - 2013/04/26/revised PY - 2013/07/09/accepted PY - 2013/8/31/entrez PY - 2013/8/31/pubmed PY - 2014/1/8/medline KW - 3-FL KW - 3-field lymphadenectomy KW - 7 KW - LNM KW - SCC KW - SEC KW - lymph node metastasis KW - squamous cell carcinoma KW - superficial esophageal cancer SP - 1198 EP - 203 JF - The Journal of thoracic and cardiovascular surgery JO - J. Thorac. Cardiovasc. Surg. VL - 146 IS - 5 N2 - OBJECTIVE: Endoscopic treatment of superficial esophageal carcinoma has been increasingly conducted around the world. Because no lymph nodes are removed in such a procedure, the risk of lymph node metastases (LNMs) should be clearly understood. The aim of the present study was to accurately clarify the pattern of lymphatic spread in patients with superficial esophageal squamous cell carcinoma and analyze the factors potentially related to LNMs. METHODS: The pattern of lymphatic spread was studied in 189 patients who had undergone radical lymphadenectomy from 2006 to 2011. The risk factors associated with LNMs were determined by multivariate logistic regression analysis. According to the depth of tumor invasion, mucosal tumors were classified as M1, M2, and M3 and submucosal tumors as SM1, SM2, and SM3. RESULTS: A total of 4252 lymph nodes were resected (average, 23 ± 9; range, 12-68). LNMs occurred in 49 patients (25.9%). The frequency of LNMs was 4.3% in those with mucosal and 33.1% in those with submucosal cancer. LNMs were found in 0%, 0%, 11.8%, 24.0%, 20.5%, and 43.8% of the M1, M2, M3, SM1, SM2, and SM3 cancer, respectively. For submucosal cancer, SM3 cancer (P = .006) and lymphovascular invasion (P = .001) were significant independent risk factors for LNMs. Paratracheal nodes were the most frequently involved. "Skip" metastases occurred in 20 of 49 patients (40.8%). CONCLUSIONS: Endoscopic treatment can be attempted when the tumor is limited to the lamina propria mucosa. However, 2-field radical lymphadenectomy with careful upper mediastinal lymph node resection should be conducted for submucosal squamous cell carcinoma. SN - 1097-685X UR - https://www.unboundmedicine.com/medline/citation/23988285/Prevalence_of_lymph_node_metastases_in_superficial_esophageal_squamous_cell_carcinoma_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0022-5223(13)00766-6 DB - PRIME DP - Unbound Medicine ER -