Analysis of lymph node metastasis and prognosis of stage N1 thoracic esophageal squamous cell carcinoma_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

ZHOU Xinpeng ,  MEI Xinyu

Department of Thoracic Surgery, The First Affiliated Hospital of University of Science and Technology of China (Auhui Provincial Hospital), Hefei, 230001, P. R. China;

Corresponding?author：

MEI Xinyu, Email: mxyahslyy@163.com

Keywords：

Esophageal cancer; squamous cell carcinoma; lymph node metastasis; N stage; prognosis

DOI：

10.7507/1007-4848.202111053

Video：

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Objective To investigate the rule of lymph node metastasis and its relationship with prognosis in stage N1 thoracic esophageal squamous cell carcinoma. Methods The clinical and follow-up data of 121 stage N1 (1 to 2 lymph node metastases) thoracic esophageal squamous cell carcinoma patients, who underwent radical resection of esophageal carcinoma in our hospital from 2015 to 2017, were retrospectively analyzed. There were 104 (86.0%) males and 17 (14.0%) females with an average age of 64.9±8.3 years. Results The early metastasis rates of the left upper paratracheal, right upper paratracheal, lower thoracic paraesophageal, paracardial, lesser curvature and greater curvature lymph nodes were 22.6%, 28.0%, 21.2%, 41.7%, 25.0% and 25.0%, respectively. The three-year survival rates in the group with and without left upper paratracheal lymph node metastasis were 8.3% and 34.9%, respectively (P=0.000). The three-year survival rates of the subcarinal lymph node metastasis group and the non-metastasis group were 10.5% and 36.3%, respectively (P=0.032). Multivariate Cox regression analysis showed that, left upper paratracheal lymph node metastasis (P=0.000) and subcarinal lymph node metastasis (P=0.010) were independent prognostic factors for early stage lymph node metastasis of esophageal squamous cell carcinoma. The three-year survival rates of patients with simple abdominal lymph node metastasis and those with simple thoracic lymph node metastasis were 51.1% and 25.0%, respectively (P=0.016). Conclusion The lymph nodes of N1 stage thoracic esophageal squamous cell carcinoma are more likely to metastasize to left upper paratracheal lymph nodes, right upper paratracheal lymph nodes, lower thoracic paraesophageal lymph nodes, paracardial lymph nodes, lesser curvature of stomach and greater curvature of stomach lymph nodes. Lymph node metastases of left upper paratracheal and subcarinal are independent factors for the prognosis of patients with stage N1 thoracic esophageal squamous cell carcinoma. The prognosis of patients with simple abdominal lymph node metastasis is better than that of patients with simple thoracic lymph node metastasis.

Citation： ZHOU Xinpeng, MEI Xinyu. Analysis of lymph node metastasis and prognosis of stage N1 thoracic esophageal squamous cell carcinoma. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2022, 29(12): 1587-1593. doi: 10.7507/1007-4848.202111053 Copy

1.	Chen W, Zheng R, Zeng H, et al. Annual report on status of cancer in China, 2011. Chin J Cancer Res, 2015, 27(1): 2-12.
2.	Tachimori Y, Nagai Y, Kanamori N, et al. Pattern of lymph node metastases of esophageal squamous cell carcinoma based on the anatomical lymphatic drainage system. Dis Esophagus, 2011, 24(1): 33-38.
3.	Amin MB, Edge SB, Greene FL, et al. AJCC cancer staging manual. 8th ed. New York: Springer, 2017. 185-202.
4.	Gockel I, Sgourakis G, Lyros O, et al. Dissection of lymph node metastases in esophageal cancer. Expert Rev Anticancer Ther, 2011, 11(4): 571-578.
5.	Rice TW, Blackstone EH, Adelstein DJ, et al. N1 esophageal carcinoma: The importance of staging and downstaging. J Thorac Cardiovasc Surg, 2001, 121(3): 454-464.
6.	Hagens ERC, van Berge Henegouwen MI, Gisbertz SS. Distribution of lymph node metastases in esophageal carcinoma patients undergoing upfront surgery: A systematic review. Cancers (Basel), 2020, 12(6): 1592.
7.	Hsu PK, Huang CS, Hsieh CC, et al. Role of right upper mediastinal lymph node metastasis in patients with esophageal squamous cell carcinoma after tri-incisional esophagectomies. Surgery, 2014, 156(5): 1269-1277.
8.	Guo X, Mao T, Gu Z, et al. Clinical study on postoperative recurrence in patients with pN1 esophageal squamous cell carcinoma. Thorac Cancer, 2015, 6(2): 146-150.
9.	Kikuchi H, Takeuchi H. Future perspectives of surgery for esophageal cancer. Ann Thorac Cardiovasc Surg, 2018, 24(5): 219-222.
10.	Bollschweiler E, Plum P, M?nig SP, et al. Current and future treatment options for esophageal cancer in the elderly. Expert Opin Pharmacother, 2017, 18(10): 1001-1010.
11.	Malassagne B, Tiret E, Duprez D, et al. Prognostic value of thoracic recurrent nerve nodal involvement in esophageal squamous cell carcinoma. J Am Coll Surg, 1997, 185(3): 244-249.
12.	王鎮, 柳碩巖. 食管胸中段鱗癌喉返神經旁淋巴結清掃的臨床價值. 中華胃腸外科雜志, 2015, 18(9): 867-870.
13.	Liu JG, Hu Y, Xie X, et al. Subcarinal node metastasis in thoracic esophageal squamous cell carcinoma. Ann Thorac Surg, 2012, 93(2): 423-427.
14.	Matsubara T, Ueda M, Abe T, et al. Unique distribution patterns of metastatic lymph nodes in patients with superficial carcinoma of the thoracic oesophagus. Br J Surg, 1999, 86(5): 669-673.
15.	Feng JF, Zhao Q, Chen QX. Prognostic value of subcarinal lymph node metastasis in patients with esophageal squamous cell carcinoma. Asian Pac J Cancer Prev, 2013, 14(5): 3183-3186.
16.	Matsubara T, Ueda M, Kaisaki S, et al. Localization of initial lymph node metastasis from carcinoma of the thoracic esophagus. Cancer, 2000, 89(9): 1869-1873.
17.	Igaki H, Tachimori YJ, Kato H. Improved survival for patients with upper and/or middle mediastinal lymph node metastasis of squamous cell carcinoma of the lower thoracic esophagus treated with 3-field dissection. Ann Surg, 2004, 239(4): 483-490.
18.	Liu J, Liu Q, Wang Y, et al. Nodal skip metastasis is associated with a relatively poor prognosis in thoracic esophageal squamous cell carcinoma. Eur J Surg Oncol, 2016, 42(8): 1202-1205.
19.	Prenzel KL, Bollschweiler E, Schr?der W, et al. Prognostic relevance of skip metastases in esophageal cancer. Ann Thorac Surg, 2010, 90(5): 1662-1667.

1. Chen W, Zheng R, Zeng H, et al. Annual report on status of cancer in China, 2011. Chin J Cancer Res, 2015, 27(1): 2-12.
2. Tachimori Y, Nagai Y, Kanamori N, et al. Pattern of lymph node metastases of esophageal squamous cell carcinoma based on the anatomical lymphatic drainage system. Dis Esophagus, 2011, 24(1): 33-38.
3. Amin MB, Edge SB, Greene FL, et al. AJCC cancer staging manual. 8th ed. New York: Springer, 2017. 185-202.
4. Gockel I, Sgourakis G, Lyros O, et al. Dissection of lymph node metastases in esophageal cancer. Expert Rev Anticancer Ther, 2011, 11(4): 571-578.
5. Rice TW, Blackstone EH, Adelstein DJ, et al. N1 esophageal carcinoma: The importance of staging and downstaging. J Thorac Cardiovasc Surg, 2001, 121(3): 454-464.
6. Hagens ERC, van Berge Henegouwen MI, Gisbertz SS. Distribution of lymph node metastases in esophageal carcinoma patients undergoing upfront surgery: A systematic review. Cancers (Basel), 2020, 12(6): 1592.
7. Hsu PK, Huang CS, Hsieh CC, et al. Role of right upper mediastinal lymph node metastasis in patients with esophageal squamous cell carcinoma after tri-incisional esophagectomies. Surgery, 2014, 156(5): 1269-1277.
8. Guo X, Mao T, Gu Z, et al. Clinical study on postoperative recurrence in patients with pN1 esophageal squamous cell carcinoma. Thorac Cancer, 2015, 6(2): 146-150.
9. Kikuchi H, Takeuchi H. Future perspectives of surgery for esophageal cancer. Ann Thorac Cardiovasc Surg, 2018, 24(5): 219-222.
10. Bollschweiler E, Plum P, M?nig SP, et al. Current and future treatment options for esophageal cancer in the elderly. Expert Opin Pharmacother, 2017, 18(10): 1001-1010.
11. Malassagne B, Tiret E, Duprez D, et al. Prognostic value of thoracic recurrent nerve nodal involvement in esophageal squamous cell carcinoma. J Am Coll Surg, 1997, 185(3): 244-249.
12. 王鎮, 柳碩巖. 食管胸中段鱗癌喉返神經旁淋巴結清掃的臨床價值. 中華胃腸外科雜志, 2015, 18(9): 867-870.
13. Liu JG, Hu Y, Xie X, et al. Subcarinal node metastasis in thoracic esophageal squamous cell carcinoma. Ann Thorac Surg, 2012, 93(2): 423-427.
14. Matsubara T, Ueda M, Abe T, et al. Unique distribution patterns of metastatic lymph nodes in patients with superficial carcinoma of the thoracic oesophagus. Br J Surg, 1999, 86(5): 669-673.
15. Feng JF, Zhao Q, Chen QX. Prognostic value of subcarinal lymph node metastasis in patients with esophageal squamous cell carcinoma. Asian Pac J Cancer Prev, 2013, 14(5): 3183-3186.
16. Matsubara T, Ueda M, Kaisaki S, et al. Localization of initial lymph node metastasis from carcinoma of the thoracic esophagus. Cancer, 2000, 89(9): 1869-1873.
17. Igaki H, Tachimori YJ, Kato H. Improved survival for patients with upper and/or middle mediastinal lymph node metastasis of squamous cell carcinoma of the lower thoracic esophagus treated with 3-field dissection. Ann Surg, 2004, 239(4): 483-490.
18. Liu J, Liu Q, Wang Y, et al. Nodal skip metastasis is associated with a relatively poor prognosis in thoracic esophageal squamous cell carcinoma. Eur J Surg Oncol, 2016, 42(8): 1202-1205.
19. Prenzel KL, Bollschweiler E, Schr?der W, et al. Prognostic relevance of skip metastases in esophageal cancer. Ann Thorac Surg, 2010, 90(5): 1662-1667.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Analysis of lymph node metastasis and prognosis of stage N1 thoracic esophageal squamous cell carcinoma

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