The pattern of cervical lymph node metastasis in thoracic esophageal squamous cell carcinoma may affect the target decision for definitive radiotherapy

作者：Chen, Junqiang^*; Cai, WenJie; Zheng, Xiongwei; Chen, Yuanmei; Lin, Yu; Chen, Xiaohui; Zhu, Kunshou; Chen, Chuanben

来源：Radiotherapy and Oncology, 2017, 123(3): 382-386.

DOI：10.1016/j.radonc.2017.04.011

• Esophageal cancer
• Cervical lymph node
• Metastasis
• Radiation therapy
• Three field lymphadenectomy

Background: Metastasis to lymph nodes is a key determinant of thoracic esophageal squamous cell carcinoma (TE-SCC) prognosis. We sought to identify factors linked with cervical lymph node metastasis, which could be used to inform the decision of surgical and definitive radiotherapy. @@@ Methods: We retrospectively reviewed records from 1715 patients who had had radical esophagectomy with three-field lymphadenectomy between January 1993 and March 2007 in our hospital. All patients included in the study had pathologically confirmed TE-SCC and no clinical evidence of cervical metastasis. @@@ Results: Cervical node metastases were found in 547 patients (31.9%); rates of cervical-node positivity were 44.2% for those with upper-thoracic tumors, 31.5% for mid-thoracic tumors, and 14.4% for lower thoracic tumors. Univariate analysis showed that cervical node metastasis was associated with tumor site, differentiation, and length, pathologic T status, and pN status (P < 0.05); however, only tumor site and pN status retained significance in multivariate analysis (P < 0.05). Positive cervical nodes were most often found in the paraesophageal region (72.3%), followed by supraclavicular (24.4%); involvement of deep cervical (2.4%) or retropharyngeal nodes (0.9%) was rare (P < 0.0001). Positive cervical nodes were most often associated with upper TE-SCCs (60.1%), followed by middle TE-SCCs (31.2%) and lower TESCCs (10.6%). @@@ Conclusions: Upper TE-SCC with multiple involved nodes at any site was' associated with a high rate of cervical node metastasis. These findings provide critical information for clinical decision-making regarding the extent of nodal dissection or the size of radiation fields in definitive radiotherapy.

• 出版日期2017-6
• 单位福建医科大学; 福建省肿瘤医院