Solitary Celiac Lymph Node Metastasis Has a Better Long-Term Survival Compared With Solitary Mediastinal Lymph Node Metastasis in Esophagectomy of Esophageal Squamous Cell Cancer: A Propensity Score Matching Analysis.

Xian-Feng Xie,Xiao-Long Zhao,Jiang Long,Tao Bao,Kun-Kun Li,Ying-Jian Wang,Wei Guo

doi:10.3389/fonc.2022.834552

Abstract

BackgroundThe prognostic benefit of extensive lymphadenectomy remains controversial in esophageal squamous cell carcinoma (ESCC). The purpose of this retrospective study was to investigate the potential effect of solitary mediastinal (SM) lymph node metastasis and solitary celiac (SC) lymph node metastasis on the short- and long-term outcomes for patients who underwent minimally invasive McKeown esophagectomy.MethodsFrom September 2009 to December 2020, a total of 934 cases were diagnosed with ESCC and underwent minimally invasive McKeown esophagectomy in our department; 223 cases met the inclusion and exclusion criteria. Propensity score matching (PSM) was utilized to contrast the postoperative results and long-term survival of Group 1 (SM) and Group 2 (SC). Univariate and multivariate Cox proportional hazards regression analyses were used on possible predictors of survival.ResultsOne hundred forty-seven patients were available for outcome comparison after PSM. The postoperative results were not significantly different between the two groups. In terms of long-term survival, the 5-year disease-free survival (DFS) was 37.6% and 57.3% (p = 0.191) and 5-year disease-specific survival (DSS) was 39.7% and 68.4% (p = 0.028) for Group 1 (SM) and Group 2 (SC), respectively. Univariate and multivariate Cox proportional hazards regression analyses showed that body mass index (BMI), pathologic stage (pStage), and SC/SM grouping had significant hazard ratios (HRs), which suggested that SC is associated with better DSS.ConclusionThis cohort study showed that SC lymph node metastasis has a better long-term survival compared with SM lymph node metastasis in esophagectomy of ESCC. The results challenge the current understanding and need confirmation in further research.

Highlights

Esophageal cancer (EC) is one of the most lethal and most aggressive cancers that ranks seventh in terms of incidence and sixth in mortality overall globally [1]
Thoracic surgeons believe that they can dissect the mediastinal lymph node (LN) in a standard manner, but for celiac LNs [10], most of them are limited to dissect No 16 and No 17 stations; No 18–20 stations were widely neglected [11] [the anatomical definitions of LN stations were based on American Joint Committee on Cancer (AJCC), 8th edition [8]]
We aimed to test whether solitary mediastinal (SM) lymph node metastasis and solitary celiac (SC) LN metastasis have a different effect on the short- and long-term outcomes for patients who underwent thoracoscopic– laparoscopic McKeown esophagectomy

Summary

Introduction

Esophageal cancer (EC) is one of the most lethal and most aggressive cancers that ranks seventh in terms of incidence and sixth in mortality overall globally [1]. Esophageal squamous cell carcinoma (ESCC) is the main pathological type of EC and carries an enormous burden in China, with a combined 5-year standardized relative survival of 20.9%–40.1% [2, 3]. We aimed to test whether solitary mediastinal (SM) lymph node metastasis and solitary celiac (SC) LN metastasis have a different effect on the short- and long-term outcomes for patients who underwent thoracoscopic– laparoscopic McKeown esophagectomy. The prognostic benefit of extensive lymphadenectomy remains controversial in esophageal squamous cell carcinoma (ESCC). The purpose of this retrospective study was to investigate the potential effect of solitary mediastinal (SM) lymph node metastasis and solitary celiac (SC) lymph node metastasis on the short- and long-term outcomes for patients who underwent minimally invasive McKeown esophagectomy

Objectives

Results

Conclusion