Cervical nodal metastases of unresectable thoracic esophageal squamous cell carcinoma: Characteristics of long-term survivors after concurrent chemoradiotherapy

Abstract

Purpose To analyze the clinical implications of metastatic cervical lymph nodes in unresectable thoracic esophageal squamous cell carcinoma (SCC) after concurrent chemoradiotherapy (CRT). Methods and materials 208 thoracic esophageal SCC patients treated with concurrent CRT were analyzed retrospectively. Patients were divided into 3 groups according to different status of metastatic cervical lymph nodes: 1. CLN(-), no evidence of metastatic cervical lymph nodes; 2. CPLN(+), evidence of enlarged cervical paraesophageal lymph node without any other metastatic cervical lymph nodes; 3. OCLN(+), any other situations of enlarged cervical lymph nodes. The prognostic factors were examined univariately, then selected for inclusion in a multivariate Cox regression model. Results Three-year OS of CLN(−),CPLN(+), and OCLN(+) groups were 39%, 33%, and 15% (logrank p = 0.001). On univariate analysis, variables significantly associated with OS included sex, primary esophageal tumor location, length and cervical nodal disease. On multivariate analysis, primary tumor location (HR1.5, 95%CI 1.1–1.9, p = 0.005), tumor length (HR1.5, 95%CI 1.1–2.0, p = 0.010) and cervical nodal disease (HR1.2, 95%CI 1.0–1.5, p = 0.014) were prognostic factors on OS. Conclusions (1) Primary tumor location, tumor length, and cervical nodal disease were significant prognostic factors on OS in esophageal SCC patients. (2) Patients with CPLN(+) disease tended to have a potential better long-term survival than those with OCLN(+) disease, and metastatic CPLN could be considered as local disease. The survival benefit in CPLN(+) subgroup might be contributed by the patients who presented with upper third thoracic tumors and shorter tumor length. Further investigation is needed.