Abstract
PurposeTo determine the prognostic significance of unilateral cervical lymph nodal metastasis (CLNM) in patients with inoperable thoracic esophageal squamous cell carcinoma (SCC) and to identify significant prognostic factors in these patients.Patients and methodsThis retrospective study involved 395 patients with inoperable esophageal SCC treated with concurrent chemoradiotherapy. The patients were classified into three groups according to their cervical lymph node status: group A, no evidence of CLNM; group B, unilateral CLNM; group C, other distant metastases. Overall survival (OS) and progression-free survival (PFS) were calculated. Significant prognostic factors were identified using univariate and multivariate analyses.ResultsThe 3-year OS rates in groups A, B and C were 46.7%, 33.5% and 8.3%, respectively (p<0.001, log-rank test). The corresponding PFS rates were 40.7%, 26.4% and 4.7% (p<0.001, log-rank test). Group B had a similar prognosis to that of group A and better 3-year OS (p = 0.009) and PFS (p = 0.006) rates than those of group C. Multivariate analysis demonstrated that T stage, chemotherapy regimen and cervical lymph node involvement were independent prognostic factors affecting OS and PFS.ConclusionsCompared to other distant metastases, unilateral CLNM is associated with longer OS in esophageal SCC and should be regarded as a regional disease. Sex, T stage, concurrent chemotherapy modality and cervical lymph node involvement are independent predictors of survival in esophageal SCC.
Highlights
Esophageal cancer is one of the most life-threatening tumors, with a 5-year survival rate of only 17% [1]
Compared to other distant metastases, unilateral cervical lymph node metastasis (CLNM) is associated with longer Overall survival (OS) in esophageal squamous cell carcinoma (SCC) and should be regarded as a regional disease
Numerous studies have shown that some patients with thoracic esophageal squamous cell carcinoma (SCC) and cervical lymph node metastasis (CLNM) could have better long-time survival than patients with visceral metastasis, which suggests that CLNM should be regarded as regional spread rather than distant metastasis [2,3,4]
Summary
Esophageal cancer is one of the most life-threatening tumors, with a 5-year survival rate of only 17% [1]. Numerous studies have shown that some patients with thoracic esophageal squamous cell carcinoma (SCC) and cervical lymph node metastasis (CLNM) could have better long-time survival than patients with visceral metastasis, which suggests that CLNM should be regarded as regional spread rather than distant metastasis [2,3,4]. The American Joint Committee on Cancer (AJCC 7th edition) defined cervical paraesophageal nodes as regional nodes in the case of esophageal cancer [6]. The prognostic significance of unilateral CLNM in esophageal cancer, if any, has not yet been explored in detail.
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