Pattern of lymphatic spread in thoracic esophageal squamous cell carcinoma: A single-institution experience

Abstract

Objectives: Lymph node metastasis is among the most important prognostic factors for patients with esophageal squamous cell carcinoma after curative esophagectomy; however, the extent of lymphadenectomy is still controversial. The objective of the present study was to determine the frequency of lymphatic metastases and to study the pattern of lymph node metastasis in a large study population.

Methods: The data from 1361 patients with thoracic esophageal squamous cell carcinoma who underwent curative R0 esophagectomy were retrospectively examined. Logistic regression analysis was used to identify the factors associated with lymph node metastasis.

Results: Of the 1361 patients, 714 (52.5%) were found to have lymph node metastasis. The frequency of lymph node metastasis increased as the tumor invasion increased. Paratracheal nodes were the most frequent metastasis nodes (15.9%). The frequency of lymph node metastasis was 9.8% in the neck, 18.0% in the upper mediastinum, 18.9% in the middle mediastinum, 11.8% in the lower mediastinum, and 28.4% in the abdomen. Of these 714 patients, 424 (31.2%) presented with 1 field involvement, 255 (18.7%) with 2 fields, and 35 (2.6%) with 3 fields involvement. Logistic regression analysis revealed tumor length (P < .001), tumor invasion (P < .001), tumor differentiation (P = .003), and lymphovascular invasion (P < .001) were risk factors for lymph node metastasis. Tumor location (P < .001), tumor invasion (P = .003), lymphovascular invasion (P = .004), and paratracheal lymph node involvement (P = .002) were identified as risk factors for cervical lymph node metastasis.

Conclusions: Metastases were more frequent in the abdomen than in the neck. Total mediastinal and upper abdominal lymphadenectomy should be carefully conducted. Certain factors, such as tumor location, depth of tumor invasion, lymphovascular invasion, and paratracheal lymph node involvement, might be helpful in determining the need to perform cervical lymphadenectomy in individual patients.