Prognostic significance of solitary lymph node metastasis in patients with squamous cell carcinoma of middle thoracic esophagus

Abstract

BackgroundThe aim of this study is to compare clinical outcomes between patients with solitary lymph node metastasis and node-negative (N0) patients in squamous cell carcinoma of the middle thoracic esophagus.MethodsA series of 135 patients with squamous cell carcinoma of the middle thoracic esophagus were retrospectively investigated. There were 33 patients with solitary lymph node metastasis and 102 N0 patients. Skip metastasis in 33 patients with solitary lymph node metastasis was defined according to three criteria: Japanese Society for Esophageal Disease (JSED), American Joint Commission on Cancer (AJCC), and the anatomical compartment.ResultsIn 33 patients with solitary lymph node metastasis, skip metastasis was shown in 13, 23, and 8 patients according JSED, AJCC and anatomical compartment respectively. The 5-year survival rates for N0 patients and patients with solitary lymph node metastasis were 58% and 32% respectively (P =0.008). Multivariate analysis revealed that skip metastasis was not an independent prognostic factor.ConclusionsFor patients with middle thoracic esophageal squamous cell carcinoma, solitary lymph node metastasis has a negative impact on survival compared with N0 disease; skip metastasis, however, is comparable to N0 diseases in predicting prognosis.

Nodal skip metastasis is associated with a relatively poor prognosis in thoracic esophageal squamous cell carcinoma

“…16 Due to the heterogeneity of selected patients and the different lymph node classification used to define NSM, the incidences of NSM were significant different in previous studies, ranged from 20% to 73.6%. 11,14,15,22 The incidence of NSM in this cohort was 63.5% in line with the results in the literatures. The prognostic impact of NSM in esophageal carcinoma has been unclear.…”

The extent of lymphadenectomy in esophageal resection for cancer should be standardized

“…Wu et al compared the prognostic significance of solitary lymph node metastasis in patients with squamous cell carcinoma of the middle thoracic squamous cell carcinoma of the esophagus with a cohort of N0 patients with the same location of the squamous cell carcinoma. They found that solitary lymph node metastasis has a negative impact on survival compared with N0 disease; skip metastasis, however, is comparable to N0 diseases in predicting prognosis (29).…”

“…Metastasis to anatomically distant lymph nodes, without metastasis in the direct environment are known as skip metastasis and can develop in the early phase of lymphatic invasion in patients with esophageal cancer (29). Regardless of primary tumor localization, 20% to 40% of patients with esophageal cancer have cervical lymph node metastasis (9,12).…”

“…One can only conclude that there is great variation and a wide field of spread of lymph node metastases in esophageal squamous cell carcinoma. Therefore, in squamous cell carcinoma a 3-field lymph node dissection should be advised on the basis of literature (9,28,29). The results of a meta-analysis comparing 2-field versus 3-field lymph node dissection, including two randomized controlled trials and 18 observational studies with over 7,000 patients, show that 3-field lymphadenectomy improves overall survival rate but is accompanied by more recurrent nerve palsy and anastomotic leakages (28).…”

“…Regardless of primary tumor localization, 20% to 40% of patients with esophageal cancer have cervical lymph node metastasis (9,12). It is important to study the prognosis of patients with a solitary lymph node metastasis compared to patients with multiple metastatic nodes meaning systematic disease with poor prognosis (29). These so-called 'skip metastases', along with the complex lymphatic system surrounding the esophagus, contribute to the fear of invisible micro metastases distant of the primary tumor site and it prompts surgeons to perform a more extended lymphadenectomy accompanying esophageal resection.…”