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Patterns and Influence of Lymph Nodal Metastases After Neoadjuvant Chemotherapy and Surgery for Thoracic Esophageal Squamous Cell Carcinoma

  • Thoracic Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Purpose

The purpose of this retrospective study was to define the pattern of lymph nodal metastases in patients with esophageal squamous cell carcinoma (ESCC) after neoadjuvant chemotherapy (NCT) followed by esophagectomy and to evaluate its influence on prognosis.

Methods

A total of 398 patients with clinical stage T3N0 or T1-3N+ ESCC who underwent NCT and radical esophagectomy with two-field lymphadenectomy were included. The distribution and frequency of metastases were counted separately for each lymph node station. The ypN stage, number of positive lymph node stations and lymph node stations with a metastasis rate greater than 5% were analyzed by using univariate Cox regression, followed by separate multivariable Cox regression analyses after adjusting for various clinical factors.

Results

Lymph node metastases were most frequently observed in the right upper paratracheal (16.8%) and left gastric artery (13.1%) stations. Multivariable models controlling for clinical factors showed that ypN stage remained a significant independent predictor of survival (N1 vs. N0: hazard ratio [HR], 2.30, 95% confidence interval [CI] 1.38–3.83, P < 0.001; N2 vs. N0: HR, 3.76, 95% CI 2.21–6.38, P < 0.001; N3 vs. N0: HR, 7.14, 95% CI 3.78–13.48, P < 0.001). The model from the multivariable analysis with the highest c-index score, indicating superior discriminatory preference, was ypN stage (c-index, 0.72).

Conclusions

The pattern and influence of lymph node metastases after NCT will provide guidance on the extent of lymphadenectomy. Common positive lymph node stations for thoracic ESCC after NCT include the paratracheal, subcarinal, paraesophageal, paracardial, and left gastric artery stations.

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Funding

This study was funded by the Province-Ministry Co-construction Project of Health Committee of Henan Province (SB201901108), Youth Talent Project of Henan Youth Health Science and Technology Innovation Foundation (YXKC2020022) and Key Scientific and Technological Project of Science and Technology Department of Henan Provincial (222102310170).

Author information

Author notes

  1. Hai-Bo Sun and Duo Jiang have been contributed equally to this work and should be considered co-first author.

Authors and Affiliations

  1. Department of Thoracic Surgery, The Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, Zhengzhou, China

    Hai-Bo Sun MD, PhD, Duo Jiang MD, Xian-Ben Liu MD, Wen-Qun Xing MD, Pei-Nan Chen MD, PhD & Sen Yan MD

  2. Department of Thoracic Surgery, Anyang Tumor Hospital, Anyang, China

    Shao-Kang Feng MD

Authors
  1. Hai-Bo Sun MD, PhD
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  2. Duo Jiang MD
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  4. Wen-Qun Xing MD
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  5. Pei-Nan Chen MD, PhD
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  6. Shao-Kang Feng MD
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  7. Sen Yan MD
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Correspondence to Hai-Bo Sun MD, PhD.

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Sun, HB., Jiang, D., Liu, XB. et al. Patterns and Influence of Lymph Nodal Metastases After Neoadjuvant Chemotherapy and Surgery for Thoracic Esophageal Squamous Cell Carcinoma. Ann Surg Oncol 30, 5205–5212 (2023). https://doi.org/10.1245/s10434-023-13634-w

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  • DOI: https://doi.org/10.1245/s10434-023-13634-w

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