Effect of Cervical Paraesophageal Lymph Node Metastasis Versus Supraclavicular Lymph Node Metastasis on the Overall Survival of Patients with Thoracic Esophageal Squamous Cell Carcinoma: A Long-term Survival Analysis

Background: Esophageal cancer (EC) is a major global health burden, with a particularly high incidence in East Asia. Supraclavicular lymph node metastasis(LNM) has notable effects on the overall survival (OS) of patients with EC after esophagectomy. We aimed to investigate the effect of LNM in cervical paraesophageal lymph nodes (station 101) and supraclavicular lymph nodes (station 104) on the OS of patients who underwent esophagectomy for esophageal squamous cell carcinoma (ESCC). Methods: : Data were obtained from the Sichuan Cancer Hospital & Institute Esophageal Cancer Case Management (SCH-ECCM) database. We retrospectively analyzed the patients with EC who underwent esophagectomy from January 2010 to December 2017. These patients were allocated into two groups based on the presence of LNM in the cervical paraesophageal or supraclavicular regions. Clinical outcomes and survival data were compared using the TNM staging system of the 8th edition of American Joint Committee on Cancer (AJCC). Results: : After a median follow-up of 62.1 months, 122 patients with LNM in the supraclavicular region were included in the study. Among these patients, 53 showed cervical paraesophageal LNM and an OS of 19.9 months (95% CI: 16.3-23.5). In contrast, 69 patients showed supraclavicular LNM with an OS of 34.9 months (95% CI 25.7-44.1). The OS rates at 1, 3, and 5 years were 77%, 29%, and 21%, respectively, for patients with cervical paraesophageal LNM. Moreover, patients with supraclavicular LNM demonstrated OS rates of 88%, 48%, and 34%, respectively (HR: 0.634, 95% CI: 0.402-1.000, P = 0.042). Conclusions: : Patients with ESCC with cervical paraesophageal LNM had significantly worse OS than those with supraclavicular LNM. This study underscores the importance of accurately identifying and managing ESCC with cervical paraesophageal LNM, as it may require more tailored and aggressive treatment strategies to prolong patient survival.