Zeng Hai, Zhu Min, Sun Yujiao, Deng Li, Fu Weiyang, Li Shuang, Xiang Ying, Zhang Weijia
Department of Oncology, First Affiliated Hospital of Yangtze University, Jingzhou, Hubei 434000, P.R. China.
Second Clinical College, Medical School of Yangtze University, Jingzhou, Hubei 434000, P.R. China.
Oncol Lett. 2024 Jul 26;28(4):462. doi: 10.3892/ol.2024.14595. eCollection 2024 Oct.
The importance of supraclavicular lymph node (SCLN) metastasis in cervical and upper thoracic esophageal squamous cell carcinoma (ESCC) has not been determined. The aim of the present study was to provide a detailed definition of the range of SCLN regions and to explore whether SCLNs should be considered as a regional lymph nodes for patients with cervical and upper thoracic ESCC. A retrospective analysis was performed on 230 patients with locally advanced cervical or upper thoracic ESCC who underwent radical radiotherapy and chemotherapy. The range of SCLN regions was defined in detail on contrast enhanced computed tomography images of the neck. According to whether the patient had lymph node metastasis in the supraclavicular region, the included patients were divided into two groups, and the survival differences and reasons for treatment failure between the two groups were analyzed. Of the 230 patients with ESCC, 71 (30.87%) exhibited lymph node metastases in the supraclavicular region. The median overall survival time of ESCC patients with and without SCLN metastasis was 17 and 30 months, respectively (P<0.001). After propensity score matching (PSM), the median overall survival time of ESCC patients with and without SCLN metastasis was 17 and 28 months, respectively (P<0.001). During the follow-up period, there were a total of 101 cases of failure of treatment in the irradiation field, 6 cases had esophageal metastasis in the non-irradiated field and 27 cases had regional lymph node metastasis in the non-irradiated field. In addition, there were 33 cases of metastasis to the distant lymph nodes or organs. There was no significant difference in the local treatment failure rate between the groups with or without SCLN metastasis in both the irradiation field and the non-irradiation field, but the probability of distant metastasis in the SCLN metastasis group was significantly higher than that in the group without SCLN metastasis (P=0.025). In conclusion, patients with cervical and upper thoracic ESCC with SCLN metastasis have a poor prognosis and the median overall survival time is closer to that of metastatic ESCC than ESCC with regional lymph node metastasis; therefore, SCLNs should not be defined as regional lymph nodes in patients with cervical and upper thoracic ESCC.
锁骨上淋巴结（SCLN）转移在颈段和胸上段食管鳞状细胞癌（ESCC）中的重要性尚未明确。本研究的目的是详细界定SCLN区域范围，并探讨颈段和胸上段ESCC患者的SCLN是否应被视为区域淋巴结。对230例接受根治性放疗和化疗的局部晚期颈段或胸上段ESCC患者进行了回顾性分析。在颈部增强计算机断层扫描图像上详细界定了SCLN区域范围。根据患者锁骨上区域有无淋巴结转移，将纳入患者分为两组，分析两组的生存差异及治疗失败原因。230例ESCC患者中，71例（30.87%）出现锁骨上区域淋巴结转移。有和无SCLN转移的ESCC患者的中位总生存时间分别为17个月和30个月（P<0.001）。倾向评分匹配（PSM）后，有和无SCLN转移的ESCC患者的中位总生存时间分别为17个月和28个月（P<0.001）。随访期间，照射野内共有101例治疗失败病例，6例在非照射野出现食管转移，27例在非照射野出现区域淋巴结转移。此外，有33例出现远处淋巴结或器官转移。照射野和非照射野中，有和无SCLN转移的组间局部治疗失败率无显著差异，但SCLN转移组远处转移概率显著高于无SCLN转移组（P=0.025）。总之，颈段和胸上段ESCC伴SCLN转移患者预后较差，中位总生存时间更接近转移性ESCC而非区域淋巴结转移的ESCC；因此，颈段和胸上段ESCC患者的SCLN不应被定义为区域淋巴结。
