Cervical nodal metastases of unresectable thoracic esophageal squamous cell carcinoma: characteristics of long-term survivors after concurrent chemoradiotherapy

Abstract

Purpose: To analyze the clinical implications of metastatic cervical lymph nodes in unresectable thoracic esophageal squamous cell carcinoma (SCC) after concurrent chemoradiotherapy (CRT).

Methods and materials: 208 thoracic esophageal SCC patients treated with concurrent CRT were analyzed retrospectively. Patients were divided into 3 groups according to different status of metastatic cervical lymph nodes: 1. CLN(-), no evidence of metastatic cervical lymph nodes; 2. CPLN(+), evidence of enlarged cervical paraesophageal lymph node without any other metastatic cervical lymph nodes; 3. OCLN(+), any other situations of enlarged cervical lymph nodes. The prognostic factors were examined univariately, then selected for inclusion in a multivariate Cox regression model.

Results: Three-year OS of CLN(-),CPLN(+), and OCLN(+) groups were 39%, 33%, and 15% (logrank p=0.001). On univariate analysis, variables significantly associated with OS included sex, primary esophageal tumor location, length and cervical nodal disease. On multivariate analysis, primary tumor location (HR1.5, 95%CI 1.1-1.9, p=0.005), tumor length (HR1.5, 95%CI 1.1-2.0, p=0.010) and cervical nodal disease (HR1.2, 95%CI 1.0-1.5, p=0.014) were prognostic factors on OS.

Conclusions: (1) Primary tumor location, tumor length, and cervical nodal disease were significant prognostic factors on OS in esophageal SCC patients. (2) Patients with CPLN(+) disease tended to have a potential better long-term survival than those with OCLN(+) disease, and metastatic CPLN could be considered as local disease. The survival benefit in CPLN(+) subgroup might be contributed by the patients who presented with upper third thoracic tumors and shorter tumor length. Further investigation is needed.