Prognostic Value of Subcarinal Lymph Node Metastasis in Patients with Esophageal Squamous Cell Carcinoma

  • Feng, Ji-Feng (Department of Thoracic Surgery, Zhejiang Cancer Hospital) ;
  • Zhao, Qiang (Department of Thoracic Surgery, Zhejiang Cancer Hospital) ;
  • Chen, Qi-Xun (Department of Thoracic Surgery, Zhejiang Cancer Hospital)
  • Published : 2013.05.30


Purpose: The 7th edition of the American Joint Committee on Cancer Staging Manual for esophageal cancer (EC) categorizes N stage according to the number of metastatic lymph nodes (LNs), irrespective of the site. The aim of this study was to determine the prognostic value of subcarinal LN metastasis in patients undergoing esophagectomy for esophageal squamous cell carcinoma (ESCC). Methods: A retrospective analysis of 507 consecutive patients with ESCC was conducted. Potential clinicopathological factors that could influence subcarinal LN metastasis were statistically analyzed. Univariate and multivariate analyses were also performed to evaluate the prognostic parameters for survival. Results: The frequency of subcarinal LN metastasis was 22.9% (116/507). Logistic regression analysis showed that tumor length (>3cm vs ${\leq}3cm$; P=0.027), tumor location (lower vs upper/middle; P=0.009), vessel involvement (Yes vs No; P=0.001) and depth of invasion (T3-4a vs T1-2; P=0.012) were associated with 2.085-, 1.810-, 2.535- and 2.201- fold increases, respectively, for risk of subcarinal LN metastasis. Multivariate analyses showed that differentiation (poor vs well/moderate; P=0.001), subcarinal LN metastasis (yes vs no; P=0.033), depth of invasion (T3-4a vs T1-2; P=0.014) and N staging (N1-3 vs N0; P=0.001) were independent prognostic factors. In addition, patients with subcarinal LN metastasis had a significantly lower 5-year cumulative survival rate than those without (26.7% vs 60.9%; P<0.001). Conclusions: Subcarinal LN metastasis is a predictive factor for long-term survival in patients with ESCC.


  1. DeMeester SR (2006). Adenocarcinoma of the esophagus and cardia: a review of the disease and its treatment. Ann Surg Oncol, 13, 12-30.
  2. Ferlay J, Shin HR, Bray F, et al (2010). Estimates of worldwide burden of cancer in 2008: GLOBOCAN 2008. Int J Cancer, 127, 2893-7.
  3. Ferguson MK, Martin TR, Reeder LB, et al (1997). Mortality after esophagectomy: risk factor analysis. World J Surg, 2, 599-603.
  4. Gotohda N, Nishimura M, Yoshida J, et al (2005). The pattern of lymphatic metastases in superficial squamous cell carcinoma of the esophagus. Hepatogastroenterology, 52, 105-7.
  5. Greene FL, Page DL, Fleming ID, et al (2002). American joint committee on cancer: AJCC cancer staging manual. 6th ed. New York: Springer.
  6. Greenstein AJ, Litle VR, Swanson SJ, et al (2008). Effect of the number of lymph nodes sampled on postoperative survival of lymph node negative esophageal cancer. Cancer, 112, 1239-46.
  7. Hsu CP, Hsu NY, Shai SE, et al (2005). Pre-tracheal lymph node metastasis in squamous cell carcinoma of the thoracic esophagus. Eur J Surg Oncol, 31, 749 -54.
  8. Japanese Society for Esophageal Disease (2008). Japanese classification of esophageal cancer. 10th ed. Tokyo: Kanehara Co.,Ltd.
  9. Kayani B, Zacharakis E, Ahmed K, et al (2011). Lymph node metastases and prognosis in oesophageal carcinoma-a systematic review. Eur J Surg Oncol, 37, 747-53.
  10. Kunisaka C, Makino I, Kimura J, et al (2010). Impact of lymphnode metastasis site in patients with thoracic esophageal cancer. J Surg Oncol, 101, 36-42.
  11. Li B, Chen H, Xiang J, et al (2012). Pattern of lymphatic spread in thoracic esophageal squamous cell carcinoma: A single-institution experience. J Thorac Cardiovasc Surg, 144, 778-85.
  12. Liu J, Hu Y, Xie X, et al (2012). Subcarinal node metastasis in thoracic esophageal squamous cell carcinoma. Ann Thorac Surg, 93, 423-7.
  13. Mao WM, Zheng WH, Ling ZQ (2011). Epidemiologic risk factors for esophageal cancer development. Asian Pac J Cancer Prev, 12, 2461-6.
  14. Mirinezhad SK, Somi MH, Jangjoo AG, et al (2012). Survival rate and prognostic factors of esophageal cancer in east Azerbaijan province, North-west of Iran. Asian Pac J Cancer Prev, 13, 3451-4.
  15. Peyre CG, Hagen JA, DeMeester SR, et al (2008). Predicting systemic disease in patients with esophageal cancer after esophagectomy: a multinational study on the significance of the number of involved lymph nodes. Ann Surg, 248, 979-85.
  16. Rice TW, Rusch VW, Ishwaran H, et al (2010). Cancer of the esophagus and esophagogastric junction: data-driven staging for the seventh edition of the American Joint Committee on Cancer/International Union Against Cancer Staging Manuals. Cancer, 116, 3763-73.
  17. Siewert JR, Stein HJ, Feith M, et al (2001). Histologic tumor type is an independent prognostic parameter in esophageal cancer: lessons from more than 1,000 consecutive resections at a single center in the Western world. Ann Surg, 234, 360-9.
  18. Sorbin LH, Wittkind CL (2002). TNM classification of malignant tumors. 6th ed. New York: Wiley & Sons.
  19. Stein HJ, Feith M, Bruecher BL, et al (2005). Early esophageal cancer: pattern of lymphatic spread and prognostic factors for long-term survival after surgical resection. Ann Surg, 42, 566-73.

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