Nodal skip metastasis is not a predictor of survival in middle thoracic esophageal squamous cell carcinoma / 中华胸心血管外科杂志

ABSTRACT

Objective To investigate the relationship of nodal skip metastasis(NSM) and clinicopathological factors of middle thoracic esophageal squamous cell carcinoma patients.Methods Between January 1999 and December 2007,695 patients with middle thoracic esophageal squamous cell carcinoma who had lymph node metastasis were reviewed.All patients received McKeown esophagectomy.We retrospectively analyzed the clinical characteristics and NSM status.Survival rates were compared using the Kaplan-Meier method and Log-Rank test.Multivariate analysis were also performed to assess the element which affect the survival by Cox regression.Results NSM were present in 226 (32.5％) patients.No significant differences in age,gender,tumor differentiation and extent of lymph node dissection depth of tumor invasion were found between skip metastasis group and continuous metastasis group.The NSM group included more patients with earlier T stage and N stage.Univariate analysis displayed that NSM was beneficial for patients with middle thoracic esophageal tumors (P ＜ 0.001).Cox-proportional multivariate analysis showed NSM was not a significant prognostic factor in overall survival.The overall survival did not differ according to NSM status in subgroups with different N stage.T1-2 patients,no significant difference of 5-year survival rate was found between skip metastasis group and continuous metastasis group(P =0.059).T3-4 patients,significant difference of 5-year survival rate was found between skip metastasis group and continuous metastasis group(P =0.001).NSM patients were then separated into 3 groups based on the extent of metastasis lymph nodesboth cervical and abdominal NSM (n =45,19.9％),cervical NSM (n =120,53.1％) and abdominal NSM (n =61,27.0％).The number of metastasis lymph nodes was significantly different among the three groups.No survival differences were observed among the three groups.Conclusion NSM is more frequently in the earlier stage compared to continuous metastasis.Three field lymphadenectomy can reduce the recurrence of T3-4 patients,and improve the survival rate of five years.The presence of NSM does not predict prognosis.