Neck Lymph Node Metastasis as A Poor Prognostic Factor in Thoracic Esophageal Squamous Cell Carcinoma Patients Receiving Concurrent Chemoradiotherapy: A Propensity Score-Matched Analysis

Yen-Hao Chen,Chien-Ming Lo,Li-Hsueh Shih,Yu-Ming Wang,Su-Wei Chen,Hung-I Lu,Shang-Yu Chou,Shau-Hsuan Li,Chang-Chun Hsiao

doi:10.1038/s41598-018-33400-3

Abstract

The present study investigated the clinical impact of neck lymph node (LN) metastasis in locally advanced inoperable thoracic esophageal squamous cell carcinoma (ESCC) patients who underwent concurrent chemoradiotherapy (CCRT) with a curative intent. There were 404 ESCC patients enrolled, including 35 patients with neck LN metastasis and 369 patients without such metastasis. Through the propensity score matching method, 35 patients of the 369 patients without neck LN metastasis were matched to the 35 patients with neck LN metastasis. Progression-free survival (PFS) and overall survival (OS) were found to be significantly worse in the neck LN metastasis group compared to the full non-neck LN metastasis group (9.8 months versus 5.9 months, P < 0.001, and 18.2 months versus 9.7 months, P = 0.001) and the matched non-neck LN metastasis group (9.9 months versus 5.9 months, P = 0.006, and 19.4 months versus 9.7 months, P = 0.007). In order to determine the difference between neck LN and supraclavicular LN metastasis, seventy patients with supraclavicular LN metastasis were also selected from the 369 patients without neck LN metastasis for comparison. Subsequently, when compared to the ESCC patients with supraclavicular LN metastasis, significantly worse PFS (8.5 months versus 5.9 months, P = 0.026) and OS (17.2 months versus 9.7 months, P = 0.047) were still found in the ESCC patients with neck LN metastasis. Our study indicates that neck LN metastasis is an independent poor prognostic factor for locally advanced inoperable thoracic ESCC patients who have undergone CCRT.

Highlights

Node (LN) metastasis when the malignancy is diagnosed, resulting in a clinically unresectable disease and poor prognosis
The area of neck lymph node (LN) is near supraclavicular LNs in terms of anatomical position, and this area is usually covered in the field of radiotherapy for those locally advanced esophageal squamous cell carcinoma (ESCC) patients receiving concurrent chemoradiotherapy (CCRT) with curative intent
There is the potential of cure for these locally advanced inoperable thoracic ESCC patients with neck LN metastasis without distant visceral metastasis when curative CCRT is performed

Summary

Introduction

Node (LN) metastasis when the malignancy is diagnosed, resulting in a clinically unresectable disease and poor prognosis. Neck LNs are regarded as distant metastasis, the area of neck LN involvement is usually covered in the field of radiotherapy for those locally advanced ESCC patients receiving CCRT with curative intent. As far as we know, the present study is the first to investigate the clinical significance of neck LN metastasis in such ESCC patients who have undergone CCRT with a curative intent. The locally advanced inoperable thoracic ESCC patients who received curative CCRT in our hospital were retrospectively reviewed, including those with neck LN metastasis but without distant metastasis. The aim of the present study was to evaluate the clinical impact of neck LN metastasis in locally advanced inoperable thoracic ESCC patients who have undergone CCRT with a curative intent

Objectives

Methods

Results

Conclusion