Abstract
BackgroundThe role of unresected small lymph nodes (LNs) which may contain metastases for thoracic esophageal squamous cell carcinoma (TESCC) has not been addressed. The aim of the study was to investigate the role of unresected small LNs assessment using computed tomography (CT) in prognostic estimates of pT3N0M0 TESCC patients.MethodsBetween January 2009 and December 2017, 294 patients who underwent esophagectomy with R0 resection at Sichuan Cancer Hospital were retrospectively examined, and the last follow-up time was July 2018. Patients were classified into CT-suspect and CT-negative groups according to the shortest diameter and the shape (axial ratio) of the unresected small LNs on preoperative CT. The Kaplan–Meier method was used to compare survival differences in prognostic factors. Univariate and multivariate analyses were performed to identify prognostic factors for survival and recurrence.ResultsEighty-four patients (28.6%) were classified as CT-suspect group according to the diagnostic criteria; survival analysis suggested that CT-suspect group of patients had a relatively poorer prognosis (P<0.05). Cox regression analysis indicated that unresected small LNs status, tumor grade, and postoperative adjuvant therapy were independent prognostic factors for patients with pT3N0M0 TESCC (P<0.05). Further analysis shown the rates of total recurrence (TR) and locoregional recurrence (LR) in the CT-suspect group were significantly higher than that in the CT-negative group (TR, P<0.001; LR, P<0.001). Among the LRs, the rate of supraclavicular lymph node recurrence in the CT-suspect group was significantly higher than that in the CT-negative group (P<0.001).ConclusionsUnresected small lymph node assessment is critically important and predict prognosis for pT3N0M0 TESCC patients.
Highlights
The role of unresected small lymph nodes (LNs) which may contain metastases for thoracic esophageal squamous cell carcinoma (TESCC) has not been addressed
Patients with confirmed pT3N0M0 TESCC according to the 8th edition of the American Joint Committee on Cancer (AJCC) Tumor–Node– Metastasis (TNM) staging system who underwent initial transthoracic subtotal esophagectomy plus lymphadenectomy with R0 resection were included
In contrast to previous studies [25], the supraclavicular lymphatic area was the most common area for locoregional recurrence (LR) in the computed tomography (CT)-suspect group with a recurrence rate of 22.6%, but the mediastinal lymphatic area was the most common area for LR in the CT-negative group with a recurrence rate of 17.6%. We believe that this might be owing to the high proportion of unresected small LNs in the supraclavicular lymphatic area in the CT-suspect group. These findings suggested that CT-suspect metastatic lymph nodes should be removed as extensively as possible during the operation, or the major postoperative failure areas, such as the supraclavicular lymphatic recurrence area, and the mediastinal lymphatic recurrence area should be carefully included in the clinical target area during postoperative radiotherapy
Summary
The role of unresected small lymph nodes (LNs) which may contain metastases for thoracic esophageal squamous cell carcinoma (TESCC) has not been addressed. The aim of the study was to investigate the role of unresected small LNs assessment using computed tomography (CT) in prognostic estimates of pT3N0M0 TESCC patients. More than 90% of ECs are pathologically diagnosed as esophageal squamous cell carcinoma (ESCC) [3,4,5]. The status of lymph nodes (LNs) has been considered as the most. For patients with pathological T3 stage and pathological N0 status, there is a high possibility of metastatic nodes to be present among unresected LNs when all removed LNs are confirmed to be pathologically cancer-negative
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
