The Prognostic Impact of Lymph Node Involvement in Large Scale Operable Node-Positive Esophageal Squamous Cell Carcinoma Patients: A 10-Year Experience

Abstract

BackgroundLymph node (LN)-related factors including the number of LN regions involved, the LN ratio (LNR), and the number of metastatic LNs are strong prognostic indicators for esophageal squamous cell carcinoma (ESCC) patients. Accurately staging LN involvement may improve the stratification of patients and guide the management of patients.MethodsA total of 688 potentially resectable patients who had regional LN metastases were enrolled in this retrospective study.ResultsESCC involving a single region was associated with better outcomes than that involving multiple regions (P < 0.001 for both PFS and OS). An increased number of metastatic LNs was significantly associated with reduced PFS and OS based on univariate analysis (P < 0.001). PFS and OS were significantly higher in patients with a lower cancer-involved LNR, with 5-year OS rates of 9.7% and 31.4% for patients with a lower and higher cancer-involved LNR, respectively. Based on multivariate analysis, patients with N1 LN involvement experienced longer survival than patients with N2 LN involvement (HR: 1.37; 95% CI: 1.12-1.68) or N3 LN involvement (HR: 1.96; 95% CI: 1.52-2.53). Higher LNR resulted in longer OS than lower LNR based on multivariate analysis (HR: 1.45; 95% CI: 1.15-1.84; P = 0.002).ConclusionsOur study has shown that not only the number of metastatic LNs but also the number of involved LN regions predicts outcomes after definitive surgery among Chinese patients with N-positive ESCC. LNR might serve as a powerful indicator that should be included in TNM staging for EC patients.

Overexpression of cannabinoid receptor 1 in esophageal squamous cell carcinoma is correlated with metastasis to lymph nodes and distant organs, and poor prognosis

“…Since it is well known that metastasis to lymph nodes is associated with a poorer prognosis in patients with ESCC, a biomarker that could predict metastatic potential in individual cases of ESCC would be clinically useful. There are several reports of candidate markers, such as trypsin, the γ 2 chain of laminin‐5, RCAS1 and p21 (WAF1), which have been shown to be correlated with lymph node metastasis .…”

Associations between the expression of MTA1 and VEGF-C in esophageal squamous cell carcinoma with lymph angiogenesis and lymph node metastasis

“…Cases of esophageal cancer in China are typically ESCC, which is the fifth most common type of cancer in China and has an associated mortality rate ranked as the fourth highest among malignant types of cancer (3). ESCC may be spread in vivo via the direct invasion of surrounding tissues, including lymphatic metastasis, hematogenous metastasis and implantation metastasis (2).…”

“…A previous study suggested that ESCC primarily exhibits metastasis via lymphatic vessels in the early stages (1,2). Therefore, investigating the factors that may affect lymph angiogenesis in ESCC, as well as the molecular mechanisms underlying lymphatic metastasis, may have vital clinical significance towards the diagnosis and treatment of ESCC (3). Vascular endothelial growth factor C (VEGF-C) is a member of the vascular endothelial growth factor family, and previous studies have demonstrated that VEGF-C participates in the lymph angiogenesis of a variety of malignant tumors, resulting in the lymph node metastasis of tumors and thus affecting prognosis (4)(5)(6).…”

The ratio of negative lymph nodes count inside the thoracic cavity to the positive lymph count is a prognostic factor in esophageal squamous cell carcinoma

“…Lymph node metastasis (LNM), or positive lymph nodes (PLN) usually occurs early in the development of ESCC, which have a prominent impact on the evaluation of tumor stage and the prognosis of patients (2)(3)(4).…”