Abstract:

Objective

To analyze the correlation between the ultrasound features of esophageal carcinoma and the levels of neutrophil to lymphocyte ratio （NLR），lymphocyte to monocyte ratio （LMR），neutrophil to monocyte ratio （NMR），and to evaluate the risk of IV lymph node metastasis.

Methods

120 patients with esophageal cancer admitted to Xi'an People's Hospital （Xi'an Fourth Hospital） from January 2021 to January 2024 were selected for endoscopic ultrasonography and ultrasonic characteristics such as lesion diameter，depth of invasion and location were recorded. According to the postoperative pathological examination results of the patients' lymph nodes，Patients with cervical region IV lymph node metastasis and those without cervical region IV lymph node metastasis were included in metastatic group and non-metastatic group，respectively. Differences in NLR，LMR and NMR among patients with different ultrasonic characteristics were compared，and differences in ultrasonic characteristics and laboratory indexes between patients with metastatic and non-metastatic region were compared. Receiver operating characteristic curve （ROC） was used to analyze ultrasonic features of esophageal cancer with NLR，LMR，and NMR，and to evaluate the area under the curve （AUC） and efficacy of cervical region IV lymph node metastasis.

Results

The NLR of patients with lesion diameter ＜2 cm was higher than that of patients with lesion diameter ≥2 cm （P＜0.05）. The NLR of patients with infiltration ＜0.5 cm was lower than that of patients with infiltration ≥ 0.5cm，and the LMR and NMR were higher than those of the latter （P＜0.05）.There was no significant difference in NLR，LMR and NMR among patients with different lesion sites（P＞0.05）. The NLR of non-invasive patients was lower than that of invasive patients，and the LMR and NMR were higher than those of the latter （P＜0.05）. The NLR of patients without microcalcification was lower than that of patients with microcalcification，and the LMR and NMR of patients with microcalcification were higher than those of the latter （P＜0.05）. Of the 120 patients，27 were found to have cervical IV lymph node metastasis，with a metastasis rate of 22.50%. There were significant differences in lesion diameter，invasion depth，envelope invasion and microcalcification between metastatic group and non-metastatic group compared with NLR，LMR and NMR （P＜0.05）. ROC curve showed that the AUC of ultrasonic characteristics combined with laboratory parameters to predict lymph node metastasis in cervical IV region of esophageal cancer was 0.833，and the sensitivity and specificity were 92.59% and 80.65%，respectively （P＜0.05）.

Conclusion

The appearance of cervical IV lymph node metastasis of esophageal cancer is accompanied by changes in the diameter，depth of invasion，capsule invasion，and calcification of esophageal cancer，and is correlated with changes in NLR，LMR，and NMR. The combined ultrasonic characteristics and laboratory parameters can provide a reliable reference for the evaluation of cervical IV lymph node metastasis.

Key words: Esophageal cancer, Endoscopic ultrasound, Thioredoxin reductase, Cervical region IV lymph node metastases