Prognostic value of left gastric artery lymph node metastasis in patients with thoracic esophageal squamous cell carcinoma: a retrospective cohort study
Year: 2025
Type: article
Study design: Observational Study
Abstract: Background: Esophageal squamous cell carcinoma (ESCC) is a common malignant tumor with high disease burden and poor prognosis. Lymph node (LN) metastasis (LNM) is a key prognostic factor for ESCC patients, particularly left gastric artery lymph nodes (No. 7) metastasis. No. 7 LNs dissection is essential for preventing residual tumor and recurrence. However, research on No. 7 LNM in ESCC remains limited. This study aimed to evaluate the independent prognostic role of No. 7 LNM in ESCC and characterize its LNM patterns by comparing isolated No. 7 LNM with No. 7 LNM combined with LNM at other sites. Methods: This study retrospectively analyzed clinical data from 144 patients with thoracic ESCC who had undergone radical esophagectomy and dissection of No. 7, recurrent laryngeal nerve (RLN, No. 106rec), subcarinal (No. 107), and main bronchial (No. 109) LNs at the Cancer Hospital of the Chinese Academy of Medical Sciences from 2019 to 2021. Postoperative follow-up included routine examinations every 3 months for the first 2 years. Lost-to-follow-up cases underwent standard right-censoring, with these data included in the final analysis. Patients were stratified into the No. 7-positive group (No. 7 LN+) and the No. 7-negative group (No. 7 LN-) based on postoperative pathological detection of No. 7 LNM. Kaplan-Meier survival analysis was used to assess the overall survival (OS) and disease-free survival (DFS) in patients with ESCC, and the Cox proportional hazards regression model was applied to identify the independent risk factors associated with OS and DFS. Results: Among 144 patients with thoracic ESCC, 75 had lower thoracic tumors, 124 received neoadjuvant therapy, and 115 had pathological stage N0-N1 disease. This study analyzed the association between No. 7 LNM and prognosis in these patients. Kaplan-Meier curves showed significantly poorer OS (P=0.007) and DFS (P=0.009) in the No. 7 LN+ group than the No. 7 LN- group. Multivariate Cox regression identified No. 7 LNM as an independent factor influencing the OS (P=0.03) and DFS (P=0.04) of patients with ESCC. Subgroup analysis of patients with No. 7 LNM revealed no significant differences in OS (P=0.33) or DFS (P=0.37) between patients with ESCC with and without 106rec LNM. However, patients with concurrent 107 LNM or 109 LNM had significantly poorer OS (P=0.02) and DFS (P=0.03) compared with those without such metastases. Furthermore, lower-thoracic ESCC patients in the No. 7 LN+ group had significantly poorer OS (P=0.04) and DFS (P=0.04) than the No. 7 LN- group. Sensitivity analysis of patients who received neoadjuvant therapy confirmed the results were robust. Conclusions: Our study confirms that No. 7 LNM is an indicator of poor prognosis in patients with thoracic ESCC. Standardized dissection of No. 7 LNs is critical during radical esophagectomy for thoracic ESCC.
Source: Journal of Thoracic Disease
Language: English
Subfield: Surgery
Field: Medicine
Domain: Health Sciences
Open Access status: diamond
OpenAlex ID: W7117677967
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