Postoperative lymphatic recurrence distribution and delineation of the radiation field in lower thoracic squamous cell esophageal carcinomas: a real-world study

Abstract

Background To study lymphatic recurrence distribution after radical surgery in the real world and guide clinical tumor volume delineation for regional lymph nodes during postoperative radiotherapy for lower thoracic squamous cell esophageal carcinomas. Methods We enrolled patients who underwent radical esophagectomy, without radiation before or after surgery, at 3 cancer hospitals. Patients were classified into groups according to tumor locations. We included patients with tumors in the lower thoracic segment and analyzed the postoperative lymph node recurrence mode. A cutoff value of 10% was used to differentiate high-risk lymph node drainage areas from others. Results We enrolled 1905 patients in the whole study series, including 652 thoracic esophageal carcinomas that met our inclusion criteria; there were 241 cases of lower thoracic esophageal carcinomas. 1st, 2nd, 4th, 7th, 8th groups of lymph nodes, according to the 8th edition of the AJCC classification, displayed as high-risk recurrence areas, representing 17.8%, 23.9%, 11.7%, 10.9% and 12.2% of lymph node recurrence. Stage III-IV tumors located in the lower segment of the thoracic esophagus showed a tendency to recur in the left gastric nodes (7.9%) and celiac nodes (10.6%). Conclusions According to our results, we recommended including the 4th, 7th and 8th groups of lymph nodes in the radiation field, and for patients with stage III-IV disease, the 17th and 20th groups of nodes should be irradiated during postoperative treatment. Whether including 1st/2nd groups in preventive irradiation needed more proofs.

Exploration of lymph node recurrence patterns and delineation guidelines of radiation field in middle thoracic oesophageal carcinomas after radical surgery: a real-world study

“…Based on our previous real-world study [ 22 ], the recurrence patterns could be slightly different in practice, and the number of recurrent lymph nodes could influence the prognosis of patients. Comprehensive treatment, including surgery and postoperative radiotherapy, not only influenced the prognosis of patients but also the patterns of lymphatic recurrence.…”

“…As far as we know, the hospitals we chose were all large centres located in central China, where was representative of high incidence of oesophageal carcinomas in China [ 25 ], hence, the results of this study could represent the classical characteristics of oesophageal cancer in our country. And this study, as a sequential study of real-world research on lower thoracic oesophageal carcinomas [ 22 ], depicted the recurrence patterns of middle thoracic carcinomas and the high-risk prognostic factors of lymphatic metastasis. The recurrence patterns of carcinomas in the two different locations suggested that there were detailed differences in the frequency of recurrence in para-oesophageal and celiac lymph nodes, but both studies showed a high recurrence rate in the supraclavicular station.…”