Clinical Impact of Abdominal Versus Mediastinal Metastases as a Prognostic Factor for Poor Outcomes Following Esophageal Cancer Surgery: A Retrospective Study

Abstract BackgroundSurgery is still the mainstay of radical treatment for resectable esophageal cancer (EC). It is apparent that the presence or spread of lymph node metastasis is a powerful prognostic factor in patients with EC who are eligible for curative treatment. Although the importance and efficacy of lymph node dissection in radical esophagectomy have been reported, the clinical or prognostic relevance of specific metastatic patterns within the mediastinal cavity and abdomen remains unclear. MethodsWe retrospectively analyzed the association between postoperative survival with clinical mediastinal lymph node metastases (cMLNMs) and abdominal lymph node metastases (cALNMs) in 143 patients who underwent radical EC surgery at our hospital between May 2012 and July 2017.ResultsA significant difference in cause-specific survival (CSS) was observed between patients with and without cALNM (log-rank p=0.000). A multivariate Cox regression analysis revealed that cALNM and thoracic surgery (mediastinal lymphadenectomy via conventional open right thoracotomy or video-assisted thoracoscopic surgery) independently predicted CSS (p=0.001 and 0.037, respectively). Moreover, a significant difference in systemic recurrence-free survival was observed between those with and without cALNM (log-rank p=0.000). Multivariate Cox regression analysis revealed that cALNM and sex independently predicted systemic recurrence-free survival (p=0.005 and 0.013, respectively). ConclusioncALNM was an independent poor prognostic factor for CSS after EC surgery. It may also be an independent prognostic factor for postoperative systemic recurrence, which can shorten CSS. For patients with cALNM-positive EC who have a high potential risk of systemic metastases, more extensive treatment besides the conventional perioperative systemic chemotherapy may be necessary.