Prognostic significance of middle paraesophageal lymph node metastasis in resectable esophageal squamous cell carcinoma: A STROBE-compliant retrospective study

Lymph node metastasis (LNM) of esophageal squamous cell carcinoma (ESCC) has important prognostic significance. In this study, we examined the correlations between lymph node metastatic sites and prognosis in patients with resectable ESCC. A total of 960 patients who received curative esophagectomy with systemic lymphadenectomy between 1996 and 2014 were included in the retrospective analysis. The Kaplan-Meier method and log-rank test were used to perform the survival analysis. The prognostic significance of LNM site was evaluated by Cox regression analysis. The LNM in middle paraesophageal (P < .001), subcarinal (P < .001), lower paraesophageal (P < .001), recurrent laryngeal nerve (P = .012), paratracheal (P = .014), and perigastric (P < .001) sites were associated with poor prognosis in univariate analysis. In multivariate analysis, only middle paraesophageal LNM (MPLNM, P = .017; HR, 1.33; 95%CI, 1.05–1.67) was the independent factor for worse prognosis. Additionally, patients with MPLNM had a lower 5-year survival rate (15.6%) than those with LNM at other sites. Furthermore, upper or middle tumor location and relatively late pN stage were associated with increased risk of MPLNM. Our findings suggested MPLNM could be a characteristic indicating the worst prognosis. Preoperative examinations should identify the existences of MPLNM, especially on patients with risk factors. And patients with MPLNM should be considered for more aggressive multidisciplinary therapies.