Nodal skip metastasis is associated with a relatively poor prognosis in thoracic esophageal squamous cell carcinoma

Nodal skip metastasis (NSM) is common in esophageal carcinoma, even with different lymph node classification criteria. The prognostic impact of NSM in esophageal carcinoma has been unclear. Some studies found no impact on survival and others found a positive impact. This research was to further investigate the incidence of NSM in patients with thoracic esophageal squamous cell carcinoma (ESCC), and assess its prognostic value in thoracic ESCC.

We retrospectively analyzed the clinical data of 340 consecutive patients with solitary lymph node metastasis who underwent esophagectomy with three-field lymph node dissection for ESCC at the First Affiliated Hospital of Zhengzhou University from January 2005 to December 2013. The survivals of the patients with NSM or adjacent node metastasis were compared.

There were 216 patients with NSM, and 124 patients with adjacent node metastasis. The incidence of NSM in this cohort was 63.5%. No significant difference was found between the patients with NSM and the patients with adjacent node metastasis in age, sex, tumor location, pathologic T stage, histologic grade, tumor length, and the number of resected lymph nodes (all p > 0.05). Patients with NSM had 5-year cumulative survival of 29.2%, which was significantly worse than the 45.6% survival in those with adjacent node metastasis (p < 0.05).

In conclusion, NSM is associated with a relatively poor prognosis in thoracic ESCC.