Role of nodal skip metastasis in patients with mid-thoracic oesophageal squamous cell carcinoma: a propensity score matching study

Abstract

OBJECTIVES Nodal skip metastasis (NSM) is a common phenomenon in mid-thoracic oesophageal squamous cell carcinoma (MT-OSCC); however, the prognostic implications of NSM in patients with MT-OSCC remain unclear. METHODS This retrospective study enrolled 300 patients with MT-OSCC who underwent radical oesophagectomy and who had pathologically confirmed lymph node metastasis from January 2014 to December 2016. The patients were divided into 2 groups according to the presence or absence of NSM. Propensity score matching was applied to minimize patient selection bias. The impact of NSM on overall survival (OS) was assessed by Kaplan–Meier and multiple Cox proportional hazards analyses. The median follow-up time was 57 months. RESULTS The NSM rate in the entire cohort was 22.0% (66/300). Pathological N (pN) stage (P < 0.001) and sex (P = 0.001) were identified as significant independent risk factors for NSM. NSM was more frequent in pN1 compared with pN2 patients (87.9% vs 12.1%, P < 0.001) and no NSM was found in pN3. NSM(+) patients had better prognoses than NSM(−) patients (Kaplan–Meier; 3-year OS, 62.1% vs 34.1%, P < 0.001). Propensity score matching produced 51 matched pairs, and the 3-year OS was still better in the NSM(+) compared with the NSM(−) group (66.7% vs 40.0%, P = 0.025). Multivariable Cox analysis confirmed NSM(+) as an independent factor favouring OS in patients with MT-OSCC. CONCLUSIONS NSM usually occurs at pN1 stage in patients with MT-OSCC, and is associated with a favourable prognosis.

Relationship between postoperative nodal skip metastasis of mid-thoracic esophageal squamous cell carcinoma and patient prognosis and its value in guiding postoperative adjuvant treatment

“…Among them, the prognosis of patients in the NSM group was significantly better than that of the NNSM group, and the site of metastatic nodes was one of the independent risk factors for predicting the prognosis of patients. This was similar to the results of Xu et al ( 8 ) in which the clinical data of 300 MT-ESCC patients with lymph node metastasis were retrospectively studied, including 66 cases (22.0%) in the NSM group. The study showed that the prognosis of patients before and after PSM was better in the NSM group than in the NNSM group (Before PSM, 3-year OS was 62.1% vs. 34.1%, P < 0.001; after PSM, 3-year OS was 66.7% vs. 40.0%, P = 0.025).…”

“…Given that the mechanism of lymph node metastasis may be related to the lymphatic drainage, micrometastasis and the biological behavior of tumor cells at the anatomical location of the tumor, the favorable prognosis of NSM patients may be related to the following factors. First, in this study, the grouping of 321 patients before PSM showed that the proportion of patients at the earlier T stage and N stage was higher in the NSM group than in the NNSM group, which was similar to many previous related studies ( 4 , 8 , 9 , 16 – 18 ). Second, the number of sites of metastatic nodes also affected the prognosis of patients undergoing surgery for esophageal cancer ( 19 ).…”

“…NSM has demonstrated a favorable prognostic effect in some solid tumors ( 6 , 7 ). In recent years, more research has focused on NSM in esophageal cancer, however, the results of its prognostic value in patients undergoing esophagectomy remain controversial ( 4 , 8 , 9 ). Therefore, it is urgent to analyze the effect of NSM on the postoperative prognosis of patients with esophageal cancer.…”

Role of Lower Esophageal Squamous Cell Carcinoma Margin Location on Abdominal Lymph Node Metastasis Risk

“…Logistic regression analysis indicated that LTM involving the EGJ was a risk factor for abdominal LNM in patients with lower ESCC, while LED less than 10 cm was a risk factor for abdominal LNM in patients with middle ESCC, and there was no significant difference in the risk of abdominal LNM between middle ESCC patients with LED less than 10 cm and lower ESCC patients without EGJ involvement. However, node skip metastasis was also frequently found in esophageal cancer patients [ 18 , 19 , 20 ], and we have to take node skip metastasis into account except consideration of tumor location and check preoperative CT scan for LNM risk carefully.…”

Construction a new nomogram prognostic model for predicting overall survival after radical resection of esophageal squamous cancer

“…In addition to TNM staging system, studies have shown that other patient characteristics may also affect the prognosis after radical resection of esophageal cancer (7)(8)(9)(10). Therefore, in this study, a new prognostic model for patients undergoing esophageal cancer radical operation was established based on the characteristics of patients by collecting and analyzing clinical data.…”