Risk Factors of Pathological Upstaging for Patients with Clinical T2N0M0 Esophageal Squamous Cell Carcinoma

Objective To investigate the risk factors for pathological upstaging of clinical T2N0M0 esophageal carcinoma by analyzing the clinicopathological data.

Methods We collected 149 patients with clinical T2N0M0 esophageal squamous carcinoma who underwent minimally invasive esophagectomy with two-field lymph node dissection. Univariate and multivariate Logistic regression analyses were performed to identify the factors related to pathologic upstaging.

Results There were 59 (39.6%) cases of pathologic T2N0M0; 23(15.4%) cases were downstaged; 67(45%) cases were upstaged; 42(28.2%) cases were pathological T upstaged; and 45(30.2%) cases had lymph node metastasis. Both T upstaging and lymph node metastasis occurred in 12.8% patients. Univariate analysis showed that tumor length, depth of infiltration, differentiation degree and pathological morphology were related to T upstaging and the influencing factors of lymph node metastasis were tumor length and depth of infiltration (P < 0.05). Multivariate analysis revealed that tumor length, depth of infiltration and differentiation degree were risk factors for T upstaging and the factors influencing lymph node metastasis were tumor length, degree of differentiation and lesion location (P < 0.05).

Conclusion Clinical staging of T2N0M0 esophageal cancer remains inaccurate. Tumor length, depth of infiltration and differentiation degree are risk factors for T upstaging. The factors influencing lymph node metastasis are tumor length, degree of differentiation and lesion location.