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. 2023 Jan 9:9:1038731.
doi: 10.3389/fsurg.2022.1038731. eCollection 2022.

Relationship between postoperative nodal skip metastasis of mid-thoracic esophageal squamous cell carcinoma and patient prognosis and its value in guiding postoperative adjuvant treatment

Hong-Mei Gao  1 , Xiao-Han Zhao  2 , Wen-Bin Shen  2 , You-Mei Li  2 , Shu-Guang Li  2 , Shu-Chai Zhu  2
Affiliations

Relationship between postoperative nodal skip metastasis of mid-thoracic esophageal squamous cell carcinoma and patient prognosis and its value in guiding postoperative adjuvant treatment

Hong-Mei Gao et al. Front Surg. .

Abstract

Objective: To evaluate the predictive role of nodal skip metastasis (NSM) in the prognosis of lymph node-positive mid-thoracic esophageal squamous cell carcinoma, and to evaluate the significance of postoperative adjuvant treatment in patients with different sites of metastatic nodes.

Methods: A retrospective analysis was performed on clinical data of 321 lymph node-positive mid-thoracic esophageal squamous cell carcinoma patients who underwent surgery in the Fourth Hospital of Hebei Medical University. Based on the site and condition of lymph node metastasis by postoperative pathology, the patients were divided into two groups: NSM group and non-NSM (NNSM) group. The propensity score matching (PSM) method was employed to match the two groups. The prognostic factors of patients before and after PSM as well as the effect of different adjuvant treatment modes on the prognosis of patients before and after PSM were analyzed. SPSS 29.0 statistical software was used for analysis.

Results: PSM in a 1 : 1 matching ratio was performed, 103 patients were assigned to NSM group and NNSM group respectively. Significant differences were found in the 3- and 5-year OS and DFS between the two groups before PSM, the 3- and 5-year OS also showed a significant difference after PSM (P < 0.05). Multivariate analysis illustrated that gender, postoperative adjuvant treatment mode, N stage and lymph node metastasis were independent risk factors for OS and DFS after PSM (P < 0.05); for NSM patients, postoperative adjuvant chemotherapy and radiotherapy significantly prolonged OS and DFS before and after PSM (P < 0.05). But no significant difference was found in OS and DFS for NNSM patients after PSM (P > 0.05).

Conclusion: Postoperative NSM is a good prognostic factor for patients with mid-thoracic esophageal squamous cell carcinoma, postoperative adjuvant chemoradiotherapy was recommended for those group, thereby gaining survival benefits.

Keywords: adjuvant treatment; esophageal neoplasms/esophageal cancer; mid-thoracic; nodal skip metastasis; prognosis; squamous cell carcinoma.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Overview of patient selection and grouping. Note: Cer: cervical; Tho: thoracic; Abd: abdominal; LNM: lymph node metastasis; MT-ESCC: mid-thoracic esophageal squamous cell cancer; NSM: nodal skip metastasis; NNSM: no-nodal skip metastasis; PSM: propensity score matching.
Figure 2
Figure 2
Analyse of patients survival and disease free survival time according the lymph node metastases status. (A) Survival analysis of all cohorts before propensity score matching. (B) Disease free survival analysis of all cohorts before propensity score matching. (C) Survival analysis of all cohorts after propensity score matching. (D) Disease free survival analysis of all cohorts after propensity score matching. Note: NSM: nodal skip metastasis; NNSM: no-nodal skip metastasis.
Figure 3
Figure 3
Analysis of postoperative adjuvant treatment modes for patients with different sites of metastatic nodes before and after propensity score matching. (A) Survival analysis of NSM patients before propensity score matching. (B) Disease free survival analysis of NSM patients before propensity score matching. (C) Survival analysis of NSM patients after propensity score matching. (D) Disease free survival analysis of NSM patients after propensity score matching. (E) Survival analysis of NNSM patients before propensity score matching. (F) Disease free survival analysis of NNSM patients before propensity score matching. (G) Survival analysis of NNSM patients after propensity score matching. (H) Disease free survival analysis of NNSM patients after propensity score matching. Note: NSM: nodal skip metastasis; NNSM: no-nodal skip metastasis; PORT: postoperative radiotherapy; POCT: postoperative chemotherapy; POCRT: postoperative radiotherapy and chemotherapy.
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