Prognostic Value of Subcarinal Lymph Node Metastasis in Patients with Esophageal Squamous Cell Carcinoma

Purpose: The 7th edition of the American Joint Committee on Cancer Staging Manual for esophagealcancer (EC) categorizes N stage according to the number of metastatic lymph nodes (LNs), irrespective ofthe site. The aim of this study was to determine the prognostic value of subcarinal LN metastasis in patientsundergoing esophagectomy for esophageal squamous cell carcinoma (ESCC).
Methods: A retrospective analysisof 507 consecutive patients with ESCC was conducted. Potential clinicopathological factors that could influencesubcarinal LN metastasis were statistically analyzed. Univariate and multivariate analyses were also performedto evaluate the prognostic parameters for survival.
Results: The frequency of subcarinal LN metastasis was22.9% (116/507). Logistic regression analysis showed that tumor length (>3cm vs ≤3cm; P=0.027), tumor location(lower vs upper/middle; P=0.009), vessel involvement (Yes vs No; P=0.001) and depth of invasion (T3-4a vsT1-2; P=0.012) were associated with 2.085-, 1.810-, 2.535- and 2.201- fold increases, respectively, for risk ofsubcarinal LN metastasis. Multivariate analyses showed that differentiation (poor vs well/moderate; P=0.001),subcarinal LN metastasis (yes vs no; P=0.033), depth of invasion (T3-4a vs T1-2; P=0.014) and N staging (N1-3vs N0; P=0.001) were independent prognostic factors. In addition, patients with subcarinal LN metastasis had asignificantly lower 5-year cumulative survival rate than those without (26.7% vs 60.9%; P<0.001).
Conclusions:Subcarinal LN metastasis is a predictive factor for long-term survival in patients with ESCC.