title: Supraclavicular node metastasis from thoracic esophageal carcinoma: A surgical series from a Japanese multi-institutional nationwide registry of esophageal cancer.
abstract: OBJECTIVE
  In the present TNM classification, involvement of supraclavicular nodes is defined as distant metastases. However, the therapeutic value of supraclavicular node dissection remains controversial. The purpose of this study was to evaluate the survival benefit of dissection of metastases to the supraclavicular lymph nodes in patients with thoracic esophageal carcinoma by using a large nationwide registry of esophageal cancer maintained by the Japanese Esophageal Society.
  
  
  METHODS
  The study group comprised 1309 patients with thoracic esophageal carcinoma treated in 2001, 2002, and 2003, who underwent esophagectomy with 3-field dissection for curative intent, and in whom the locations of pathologic metastatic lymph nodes and outcome evaluations were available.
  
  
  RESULTS
  Of 1309 patients, 559 (42.7%) had no nodal metastases, 560 (42.8%) had at least 1 positive node but were supraclavicular node-negative, and 190 (14.5%) had supraclavicular node metastases. The 5-year survival was 73.7% for patients with N0, 40.4% for node-positive patients without supraclavicular node disease, and 24.1% for patients with supraclavicular node metastasis. In a multivariate analysis, male sex (P<.001), deeper T category (P<.001), and more positive nodes (P<.001) retained statistical significance as adverse prognostic factors for overall survival. Supraclavicular node metastasis was not significant (P=.062).
  
  
  CONCLUSIONS
  The survival benefit of dissection of metastases to the supraclavicular lymph nodes was indicated in patients with thoracic esophageal carcinoma. Supraclavicular nodes appear to be regional nodes similar to other regional nodes.
authors.affiliation: Division of Esophageal Surgery, National Cancer Center Hospital, Tokyo, Japan. Electronic address: ytachimo@ncc.go.jp.
authors.forename: Yuji
authors.initials: Y
authors.lastname: Tachimori
authors.affiliation: Department of Gastroenterological Surgery, Tokai University School of Medicine, Isehara, Japan.
authors.forename: Soji
authors.initials: S
authors.lastname: Ozawa
authors.affiliation: Department of Medical Physics and Engineering, Osaka University Graduate School of Medicine, Osaka, Japan.
authors.forename: Hodaka
authors.initials: H
authors.lastname: Numasaki
authors.affiliation: Department of Frontier Surgery, Chiba University Graduate School of Medicine, Chiba, Japan.
authors.forename: Hisahiro
authors.initials: H
authors.lastname: Matsubara
authors.affiliation: Department of Thoracic Surgery, Aichi Cancer Center Hospital, Nagoya, Japan.
authors.forename: Masayuki
authors.initials: M
authors.lastname: Shinoda
authors.affiliation: Department of Gastroenterological Surgery, Kyushu Cancer Center, Fukuoka, Japan.
authors.forename: Yasushi
authors.initials: Y
authors.lastname: Toh
authors.affiliation: Department of Gastroenterological Surgery, Toranomon Hospital, Tokyo, Japan.
authors.forename: Harushi
authors.initials: H
authors.lastname: Udagawa
mesh_terms: D000230:Adenocarcinoma / Q000453:epidemiology / Q000473:pathology* / Q000601:surgery*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002294:Carcinoma, Squamous Cell / Q000453:epidemiology / Q000473:pathology* / Q000601:surgery*; D002968:Clavicle; D004938:Esophageal Neoplasms / Q000453:epidemiology / Q000473:pathology* / Q000601:surgery*; D016629:Esophagectomy; D005260:Female; D006801:Humans; D007564:Japan / Q000453:epidemiology; D008197:Lymph Node Excision; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D012042:Registries; D015996:Survival Rate