Supraclavicular lymph node metastasis in elderly patients undergoing esophageal squamous cell carcinoma radical surgery: construction of risk and prognostic predictive nomograms

BACKGROUND: Supraclavicular lymph node metastasis (SCLN) is an adverse prognostic determinant of esophageal cancer. However, lymphadenectomy for SCLN is a traumatic procedure, especially in elderly patients, which is associated with more postoperative complications. Currently, identification of risk factors of SCLN metastasis and avoidance of unnecessary lymphadenectomy for SCLN in esophageal squamous cell carcinoma (ESCC) patients has become an unmet clinical need. METHODS: A total of 90 elderly patients with ESCC between January 2008 and December 2013 was eligible for this analysis. Logistic regression was performed to determine risk factors for SCLN metastasis after ESCC radical surgery in elderly patients. A nomogram was constructed to individually predict the risk for SCLN metastasis. The Kaplan-Meier survival curve and cumulative risk curve were further analyzed to evaluate the effect of SCLN metastasis after ESCC radical surgery on survival prognosis and cumulative risk assessment in elderly patients. Finally, the SCLN metastasis group and the independent risk factor group were fitted by drawing a decision curve to evaluate the net benefit of the model. RESULTS: SCLN developed in 38 patients (42.2%). Postoperative lymph node metastasis (P<0.05), tumor thrombus (P<0.05) and tumor infiltration (P<0.05) were independent risk factors for SCLN metastasis. The influence of SCLN metastasis on postoperative survival in elderly ESCC patients was statistically significant (P=0.028, P <0.05); with the passage of time, the cumulative risk of SCLN metastasis increased, the survival probability decreased, and the survival time was shortened. CONCLUSIONS: Postoperative lymph node metastasis, tumor thrombus and tumor infiltration are independent risk factors for recurrence and metastasis of SCLNs in elderly patients with esophageal squamous cell carcinoma. The nomogram model based on these factors provides a preliminary reference for individualized risk assessment, prognosis guidance and decision-making of SCLN metastasis in elderly patients with esophageal squamous cell carcinoma (ESCC).