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1 doi: /j.issn :; XY Z[F$%& /01,,,, 2,34,5 6,78", ABCD; ;6@ R735.1 $: (ENE)EA B C D 4 P S / ' : / R0 162 ABCD,,HE? I J ENE G 8 8 ^V, V / 5a8, FG χ 2 I E ENESABCD, 4 ^PA,FG log ranki ^ b / PA,FG COX ENE E6@ :87 (53.7%), / ENE ENE / ^! A B C D 4 P S 2 P B, b / PA< ENE, / ENE, (P<0.001) b P A <,ENE A BCD/ _` b (P<0.001), ENE A B D, b < U (RR=4.747,95% CI 3.092~7.290) : - ENE TNM P,c 6@ ENE ABCD, 6@c,F ^!, V S>.,)*+,,, /,01,,&' : 2!,E mail:fengw010@163.com

2 JournalofZhengzhouUniversity(MedicalSciences) May 2018 Vol.53 No Theinfluenceoflymphnodesextranodalextensionofesophagealsqua mouscelcarcinomaontheprognosticfactors CHENDanjie,MENGXiangrui,LIUCan,LIU Ying,MENGYachao,LIU De en,xin Dao,FAN Qingxia, WANGFeng DepartmentofOncology,theFirstAfiliatedHospital,ZhengzhouUniversity,Zhengzhou Keywords esophagealsquamouscelcarcinoma;extranodalextensionoflymphnode;prognosis Abstract Aim:Toexploretheimpactofextranodalextension(ENE)onthepathologicalstageandprognosisofe sophagealsquamouscelcarcinoma.methods:totaly162casesofsquamouscelcarcinomaoftheesophaguswithr0re sectionandlymphnode positivewerecolectedfrom thefirstafiliatedhospitalofzhengzhouuniversityfrom February 2010toFebruary2012.Theextranodalextensionsituationoflymphnodesinesophagealsquamouscelcarcinomawasde tectedbyhestaining.databaseforthesepatientswereestablishedbyusingoutpatientorinpatientreviewforatleast5 yearsandrelevantvariablesweredetermined.thecorelationbetweeneneandclinicopathologicalfeatureswasanalyzedby χ 2 test.univariatesurvivalanalysiswasperformedusingthelog ranktest.multivariateanalysiswasperformedusingthe COXproportionalhazardsregressionmodeltodeterminetheefectofENEontheprognosis.Results:Therewere87in162 cases(53.7%)ofesccoccuredene.theincidenceofeneiscloselyrelatedtothepathologicalstageandthedegreeof tumordiferentiationofescc.univariatesurvivalanalysisshowedthatthesurvivalofthepatientswithene(19months) wassignificantlylowerthanthosewithoutene(35months)(p<0.001).multivariateanalysisshowedthatenewasanin dependentprognosticfactorforesophagealsquamouscelcarcinoma(p<0.001).theriskofal causemortalitywassignifi cantlyincreasedinpatientswithene(rr=4.747,95%ci ).conclusion:thestateofeneisrecommended toaddintothenewtnm stagingsystem tobeterguidetheprognosis.theprognosisofpatientswithextranodalextensionis poor.sopatientswithenepositiveshouldbegivenassistedtreatment,andfolow upofrecurenceandmetastasis. ABD # L 2 ABD ^," 2 6/ [1] ABD #$, 5R O%,%@ 5a/ ^ 4&,b,'Q ;!ABD%@ < &' [2 4], >. ABD6@ b, O (extranodalextension,ene) A BD,6@ b, 5\@ 2 6@b [5 8] ENE I 2; # (PZ &' [9] < A B D ENE, )! * A B D E A B C D & ' b &') E 162 ABCD, ^PA&', ENE ABCD, 4N!6@,, 6@ -,,. /, X, 6@ 1 \(' 1.1 ]^ \ / [#, 162 # :1 % " M 1P ct 1~4 N 1~2 M < ABCD 4,%@ 4 >. :1 4 ABD 2[ 2 3[,,, 1.2 +_ `a ` - 2ABD c3>. P, 45PZ, P 10% 6 L 7 8,9 : ;,HE? \ 4 7<= ENE, E ENE ^ % V," 2a 3. ^ 6.M1,/ 5 a; V / 5a8, V I I S ` EV ^ 4 #,,?` ] G SPSS18.0 ^ PA,FG χ 2 I P A ENES A B C D, 4,F G log ranki ^ b / PA, b PAFG COX,I α=0.05

3 ( ) ENE9:; bc 6 $Z & ' # 162,,< 1 2 T N TNMP S 2 P B! ENE / ^,c I(P<0.001) 2.2 M b PA <, 2 P B 2 2 B \ TNMP! ENE W ABC D,6@ b,!,/,c I(P 0.05) 2 2 :; b $ [FM 1 ENE9:; bc 6 $Z 4 n ENE ENE χ 2 P = /> > Q /& AB O AB ? AB P B P OP <0.001 P /cm > AB CD E B \ TP T T T <0.001 T NP N N <0.001 N TNMP ⅡB ⅢA ⅢB <0.001 ⅣA ! n t(/ )/. χ 2 P = /> > (20.4~27.6) (24.5~29.5) Q (22.5~27.5) (23.7~30.8) /& AB (18.3~37.7) O AB (24.0~28.0) ? AB (17.9~24.1) P B P (32.9~37.1) OP (26.6~35.4) <0.001 P (18.8~21.2) 2 /cm > (19.2~24.8) (25.1~30.9) (14.4~23.6) AB (26.5~35.5) CD (19.2~26.8) E (18.8~31.2) B (21.4~24.6) (26.7~33.3) <0.001 \ (18.6~23.4) (26.5~29.5) TP T (35.6~42.4) T (26.4~29.6) T (21.8~28.2) <0.001 T (17.2~18.8) NP N (34.3~37.7) N (26.7~29.3) <0.001 N (18.1~20.0) TNMP ⅡB (40.6~43.4) ⅢA (28.3~37.7) ⅢB (27.4~30.6) <0.001 ⅣA (18.0~20.0)! ENE (22.8~29.2) (19.5~28.5) (17.6~20.4) < (33.2~36.8)

4 JournalofZhengzhouUniversity(MedicalSciences) May 2018 Vol.53 No O ENE, / (19. ) ENE,(35.),c I(P 0.001), 1-2 P B 2 2 B \ TNM P! ENE # COX PA, < ENE A B C D, / _ ` b ( 3 4) 1 ENE :; b$ FE TNM P ⅡB=1;ⅢA=2;ⅢB=3;ⅣA=4 \ =1; =2 ENE =1; =2! =1; =2 / G H =1; =2 4 :; b [FM B SE RR(95%CI) P TNMP (2.144~7.895) <0.001 \ (1.160~2.508) ENE (3.092~7.290) <0.001! (4.775~13.404)< D ABD 47 2, I 80% A BD O J I A B D U 45.6K, UX 28.7K, I ABD b [10 11] A B D,) O L #,, 5a/ ^ M 30%NO [12 13] N O 2 S >. 2 TNMP,6@,G SM16@ " NP >., P cw >. B &' [14], 7 AJCCP NP W 2P,6@, N2S N3, NⅢBSⅢC, / c I, ABD TNMP X D Z[ 2016 AJCC( 8 )P %adzp UICCP W 2Q >. I NP, JCECP : / & P " 2P T-R >.,cw E6@ B S@ Tc [15 16] & ' <,V NP U, ABCD ENE / ^ ` V U - #ABD TNMP,8 c S M1 2 & ' < ENE / ^! 2P B, P ABCD,U / ENE V^W Z &' [17] ENE /^S 7,) &'TE ^ X X, &' [18 19] ENE ABD >. 6@ b D annovile [20] ^ b PA < ENES TP ABD / (DFS) ^ _` b Z 2016 Luchini [21] ) E 14 &'O 1437 >.ABD, ^ metapa< :745, / ENE,O / V 39.4., ENE ABD, b ^ < U,D ^ S U & ' <,ENE, / < ENE, E ABCD/ b ^ b PA < ENE ABCD,/ _` b,ene! A B C D E %O IJ ENE,F^ Y7 %,9 %@ F!, ^%@ 8, ] >.^S, / E [1] CHEN W,ZHENG R,ZENG H,etal.Annualreporton statusofcancerinchina,2011[j].chinjcancerres, 2015,27(1):2 [2] PURWARP,BAMBARKARS,JIWNANIS,etal.Prog nosticsignificanceoflymphnodecountsinoperableesoph agealcancer[j].annthoracsurg,2014,97(6):2229 [3] ZHAOY,ZHONGS,LIZ,etal.Pathologiclymphnode ratioisapredictorofesophagealcarcinomapatientsurviv al:aliterature based pooled analysis[j]. Oncotarget, 2017,8(37):62231 % E A B C

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