Prognostic impact of thoracic duct lymph node metastasis in esophageal squamous cell carcinoma

Satoru Matsuda, Hirofumi Kawakubo, Hiroya Takeuchi, Shuhei Mayanagi, Tomoyuki Irino, Kazumasa Fukuda, Rieko Nakamura, Norihito Wada, Yuko Kitagawa

研究成果: Article査読

抄録

Aim: We have previously reported the existence of lymph nodes surrounding the thoracic duct (TDLN) and transthoracic esophagectomy (TTE) with thoracic duct (TD) resection increased the number of lymph nodes (LNs) retrieved. The current study aims to evaluate the prognostic impact of TDLN metastasis in esophageal cancer patients subdivided by its location and comparing the patients’ survival with those with extra-regional LN metastasis. Methods: Patients who underwent TTE with TD resection for esophageal squamous cell carcinoma (ESCC) were reviewed. Patients were classified into those with or without TDLN metastasis, and clinicopathological factors were compared between groups. TDLN was further divided into TDLN-Ut/Mt/Lt based on the location in the mediastinum. The relapse-free survival (RFS) and overall survival (OS) were compared between groups. Results: Of 232 patients, TDLN metastasis was observed in 17 (7%). RFS and OS were significantly worse in the TDLN metastasis group. TDLN metastasis was shown to be an independent prognostic factor for RFS and OS in the multivariate analysis. The negative prognostic impact of TDLN metastasis was evident in TDLN-Mt/Lt. The RFS and OS of patients with TDLN metastasis were almost identical to those with positive LN metastasis in extra-regional LNs. Conclusion: TDLN metastasis was proven to be a strong prognostic indicator. Although the TDLN has been included in the classification of regional LN in the current staging systems, it could be independently classified from the current regional LNs. Given that neoadjuvant therapy has been a standard, we might need to introduce adjuvant therapy when TDLN metastasis is observed.

本文言語English
ページ(範囲)321-330
ページ数10
ジャーナルAnnals of Gastroenterological Surgery
5
3
DOI
出版ステータスPublished - 2021 5

ASJC Scopus subject areas

  • Surgery
  • Gastroenterology

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