Pre-tracheal lymph node metastasis in squamous cell carcinoma of the thoracic esophagus.
OBJECTIVE
To clarify the incidence of pre-tracheal lymph node metastasis in squamous cell carcinoma of the esophagus, and their impact on survival.


METHODS
A cohort of 101 patients with squamous cell carcinoma of the thoracic esophagus who underwent esophagectomy together with 2-field lymphadenectomy including the pre-tracheal region was analysed, retrospectively. The p-TNM staging included stage I in 9, stage IIa in 33, stage IIb in 4, stage III in 43, and stage IV in 12 cases.


RESULTS
Nodal metastases were identified in 56 patients (55.4%). Subcarinal lymph node and pre-tracheal lymph-node metastases were found in 24 patients (23.8%) and 15 patients (14.9%), respectively. The 5-year cumulative survival rates were 26.5 and 2.5% in nodal negative and nodal positive patients, respectively. Patients with pre-tracheal nodal metastasis all died within 2 years. Cox proportional hazards model in patients with nodal involvement revealed T-factor (p=0.0017), pre-tracheal nodal involvement (p=0.0055) and distant metastasis (p=0.0024) as independent prognostic factors.


CONCLUSIONS
Our findings suggest that pre-tracheal lymph node metastasis indicates a dismal prognosis. Its occurrence is not unusual, especially in tumour of upper or middle thoracic esophagus. The subcarinal node cannot be regarded as a sentinel node of the pre-tracheal nodal station. Complete lymphadenectomy excluding the pre-tracheal lymph nodes in treating esophageal cancers is only a myth.
Hsu
C P
CP
Division of Thoracic Surgery, Department of Surgery, Taichung Veterans General Hospital, Taichung, Taiwan, ROC. cliff@vghtc.gov.tw
Hsu
N Y
NY
Shai
S E
SE
Hsia
J Y
JY
Chen
C Y
CY
D000328:Adult; D000368:Aged; D015331:Cohort Studies; D004938:Esophageal Neoplasms / Q000453:epidemiology / Q000473:pathology* / Q000601:surgery*; D005260:Female; D006801:Humans; D015994:Incidence; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D018307:Neoplasms, Squamous Cell / Q000453:epidemiology / Q000556:secondary* / Q000601:surgery*; D011379:Prognosis; D012189:Retrospective Studies; D016019:Survival Analysis; D014132:Trachea / Q000473:pathology*