Lymph node metastasis patterns and survival in patients with esophageal squamous cell carcinoma undergoing McKeown esophagectomy: a retrospective cohort study
Year: 2026
Type: article
Study design: Observational Study
Abstract: Background: The distribution of lymph node metastases in esophageal squamous cell carcinoma (ESCC) varies with tumor location. We examined nodal metastasis patterns and factors associated with overall survival in patients undergoing McKeown esophagectomy. Methods: This single-center retrospective study analyzed hospital records of 909 patients with ESCC who underwent McKeown esophagectomy between December 2011 and July 2019, including total minimally invasive and hybrid procedures. Nodal involvement was summarized using node-based metastatic percentages and patient-level positivity among patients with evaluable regional records. Survival was analyzed using Kaplan-Meier methods and separate univariable Cox models for nodal status and recorded tumor length. Exploratory ABO analyses used Firth logistic regression for nodal positivity and a multivariable Cox model stratified by tumor location for overall survival. Analysis-specific exclusions were applied to missing or unresolved data. Results: The cohort included 535 men (58.9%), and the mean age was 64.2±7.2 years among 904 patients with recorded age. Tumors were located in the upper, middle, and lower thoracic esophagus in 200, 603, and 106 patients, respectively; 407 patients had pT3 disease. Nodal positivity was identified in 326 of 878 patients with evaluable nodal status (37.1%). Regional nodal involvement varied by tumor location. Reliable survival data were available for 895 patients, with 347 deaths and a median follow-up of 51 months. The nodal-status analysis included 864 patients and 320 deaths within 60 months; nodal positivity was associated with poorer survival [unadjusted hazard ratio (HR), 3.054; 95% confidence interval (CI): 2.446-3.821]. Recorded tumor length >3.79 cm was also associated with poorer survival (unadjusted HR, 2.693; 95% CI: 2.162-3.372). Both P values were <0.001. In exploratory adjusted analyses, the overall ABO association was significant for survival (P=0.01), but not for nodal positivity (P=0.21). Conclusions: Nodal involvement varied by tumor location. Nodal positivity and greater recorded tumor length were associated with poorer survival in univariable analyses. These findings do not establish the benefit of changing the extent of lymphadenectomy.
Source: Journal of Thoracic Disease
Language: English
Subfield: Surgery
Field: Medicine
Domain: Health Sciences
Open Access status: diamond
OpenAlex ID: W7224093913