Prognostic value of middle paraesophageal lymph node metastasis in patients with pathologic N+ esophageal squamous...

The lymphatic drainage of the esophagus primarily depends on the lymphatic vessels within the lamina propria mucosae and submucosa, which channel lymph longitudinally toward the proximal and distal ends. Our study sought to explore the prognostic significance of the lymph node metastasis station in patients with pathologic N+ esophageal squamous cell carcinoma (ESCC).

We retrospectively reviewed 544 patients who underwent esophagectomy alone for ESCC with pathologic lymph node metastasis between January 2012 and December 2016. The sites of lymph nodes were classified into zones according to the Japanese Classification of Esophageal Cancer. Univariate analysis and multivariable Cox regression model were applied to analyze disease-free survival (DFS) and overall survival (OS).

The metastasis rate of the middle paraesophageal lymph node (station 108) was 22.2%, which was significantly associated with advanced pathologic T stage ( P < 0.001). Multivariable Cox regression analysis revealed that R0 resection, pT stage, pN stage, station 106recL, station 108 metastasis (hazard ratio, 1.485; P = 0.002), number of LN removed, and adjuvant therapy were independent prognostic factors for OS and pT stage, pN stage, station 106recR, station 108 metastasis (hazard ratio, 1.635; P < 0.001), number of LN removed, and adjuvant therapy for disease-free survival. Additional multivariate analysis showed that station 108 metastasis was an independent risk factor for locoregional recurrence-free survival (hazard ratio, 1.693; P = 0.001) and distant relapse-free survival (hazard ratio, 1.624; P = 0.001), together with pT stage, pN stage, number of LN removed, and adjuvant therapy.

The high incidence in the station 108 metastasis was noted in patients with advanced pT stage ESCC. And the station 108 metastasis was associated with a worse prognosis in ESCC with lymph node involvement.