Relationship between tumor invasion depth and lymph node metastasis of the esophageal adenocarcinoma and the effect to survival

Objective This study analyzed the relationship between tumor depth and lymph node metastasis of esophageal adenocarcinoma. Methods The study group comprised 121 patients with esophageal adenocarcinoma who underwent an attempted esophagectomy between 1985 and 2003. Overall, there were 101 male and 20 female patients with a mean age at surgery of 62 years (range 36-80). The overall resection rate was 96.7% (117/121). The number of nodes removed were 8 (range 2～30). Lymph nodes status were that negative nodes 59 (48.8%) and local node metastases 62 (51.2%). All of the patients were followed up. Results When tumor invaded mucosa or submucosa of the esophagus (T1), the lymph node metastasis rate was 22.2%(10/45), mean number of the lymph node metastasis was 0.3, and the proportion of more than 4 lymph node metastasis was 0(0/45). When tumor invasded adjacent structures of the esophagus (T4), the lymph node metastasis rate was 85.7%(6/7), mean number of the lymph node metastasis was 5.1, and the proportion of more than 4 lymph node metastasis was71.4%(5/7), P0.01. The 5-year survival was 52.9% in the group without node metastases, 11.5% in the group of 1～4 node metastases, and was 0 in the group of more than 4 node metastases, P0.01. Conclusion There was a direct proportion between the tumor depth and lymph node metastasis of the esophageal adenocarcinoma. The deeper of the tumor invasded, the rate of lymph node metastases, mean number of node metastases, and the proportion of more than 4 node metastases increased. Lymph node metastases and the number of node involved are the important factors that effect survival rate.