The relationship between maximum tumor length and lymph node metastasis in esophageal squamous cell carcinoma

Zhang Tangjuan; Li Yin; Han Weili; Wang Hailing; Ren Jingli; Lu Jianliang; Fu Wenting; Wang Lidong

doi:10.3969/j.issn.1004-437X.2016.05.002

Abstract：Objective To characterize the relationship between maximum tumor length (MTL)and lymph node metastasis (LNM) in esophageal squamous cell carcinoma (ESCC),providing an evi-dence for preoperative judgment of LNM.Methods All the 40 822 cases were from the clinical information databases of 500 000 esophageal and gastric cardiac carcinomas (1973 -2015) by the Henan Key Laboratory for Esophageal Cancer Research.Of the patients,there were 26 225 males with an average age of (60 ±9)years and 14 597 females with average age of (60 ±9)years.The MTL and LNMof 40 822 patients with ESCC were derived from postoperative pathology reports in hospitals.Based on MTL,the patients was classified into five groups (<2 cm, 2 ~4 cm,4 ~6 cm,6 ~8 cm and ≥8 cm).The difference between groups was analyzed by χ2 test;The relationship between MTL and LNM was analyzed by Spearman rank correlation and Logistic regression analysis.Results The average MTL was (4.4 ±1.8)cm,and the median MTL was 4 cm with a range of 0.3 ~16.0 cm.The number and rate of different MTL from <2 cm to ≥8 cm in 40 822 patients with ESCC were 1 489 (3.6%),13 029 (31.9%),16 924 (41.5%),7 365 (18.0%)and 2 015 (4.9%),respectively.Spearman rank correlation analysis indicated an apparent positive correlation be-tween MTL and LNM(r =0.998,P =0.000).Adjusted Logistic regression showed that MTL was an important influence factor of LNM(OR =1.329,95% CI =1.292 ~1.366,P =0.000),and MTL increased the risk of LNM (MTL =2 ~4 cm,OR =1.393,95% CI =1.177 ~1.649,P =0.000;MTL =4 ~6 cm,OR =1.944,95% CI =1.644 ~2.299,P =0.000;MTL =6 ~8 cm,OR =2.526,95% CI =2.215 ~3.003,P =0.000;MTL≥8 cm,OR =3.045,95% CI =2.507 ~3.699,P =0.000).Conclusion The MTL was closely related to lymph node metastasis in ESCC.The MTL could be used as an important clinical reference index for the evaluation of LNMstatus before operation.