The prognostic value of nodal skip metastasis in resectable thoracic esophageal squamous cell carcinoma

Abstract

PurposeThis study aimed to investigate the incidence of nodal skip metastasis (NSM) to identify the risk factors that influence NSM and to assess the prognostic value of NSM in patients with thoracic esophageal squamous cell carcinoma (ESCC).Patients and methodsBetween January 2009 and December 2013, 285 patients with ESCC with positive lymph nodes who underwent complete resection were enrolled.ResultsFor the entire group, NSM occurred in 32.3% (92/285) of patients. The median survival time and 5-year survival rate in the NSM group were 28 months and 12.0%, respectively, compared with 36.3 months and 25.0%, respectively, in the non-NSM group (P=0.008). Both N stage (P=0.001) and T stage (P=0.014) were associated with the incidence of NSM. NSM (P=0.008), T stage (P=0.000), and N stage (P=0.000) were independent prognostic factors for survival. In the NSM group, T stage (P=0.014) and N stage (P=0.000) were independent prognostic factors for survival.ConclusionIt was concluded that NSM is common in ESCC and is associated with poor survival.

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

“…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)(17)(18). Second, the number of sites of metastatic nodes also affected the prognosis of patients undergoing surgery for esophageal cancer (19).…”

Mechanisms of esophageal cancer metastasis and treatment progress

“…When tumor cells penetrate the esophageal wall through longitudinal drainage ducts and subsequently traverse transverse drainage ducts, there is a higher possibility of bypassing lymph nodes near the primary tumor and metastasizing to more distant lymph nodes, promoting the development of lymph node skip metastasis ( 22 , 23 ). Furthermore, a Japanese study found that lymphatic skip metastasis in thoracic esophageal carcinoma was associated with the absence of lymphatic vessels between the middle mediastinum and supraclavicular muscles.…”

The Prognostic Value of Nodal Skip Metastasis in Patients with Esophageal Cancer: A Systematic Review and Meta‐Analysis

“…Table 3 shows the characteristics of eligible studies. This meta-analysis included a total of 9 studies [5,[14][15][16][17][18][19][20][21] published from 2010 to 2021. Seven studies were reported in China, one was from Germany and the remained one originated from Italy.…”

“…All 9 studies [5,[14][15][16][17][18][19][20][21] including 4106 patients reported the association between NSM and OS. Statistical heterogeneity was significant (v 2 = 57.81, P \ 0.001, I 2 = 86.2%).…”