Association of supraclavicular node metastasis with survival in node positive esophageal squamous cell carcinoma patients treated using definitive chemoradiation

Background: The study aimed to assess the prognostic significance of supraclavicular lymph node (SCLN) metastasis in patients with node-positive esophageal squamous cell carcinoma (ESCC) treated using definitive chemoradiation. Methods: A total of 143 patients with newly diagnosed ESCC treated using definitive chemoradiation between 2006 and 2017 were identified retrospectively in our observational cohort study. Data for clinical characteristics, including the gross tumor volume (GTV) and radiation dose were collected. Among these patients, 71 had SCLN metastasis. Data of additional 80 ESCC patients with de novo distant metastasis were collected. Survival and failure estimates were calculated according to the methods of Kaplan-Meier. Prognostic factors were evaluated using multivariate analyses. Results: The median follow-up time was 14.3 months (range, 1.9–139.3 months) and the median overall survival (OS) of the entire cohort was 16.1 months [95% confidence interval (CI), 12.9–20.7 months]. The 2-year survival rates were similar in patients with and without SCLN metastasis (32.8%, P=0.88). Time to failure was also similar between the two groups (P=0.54). There was a significant 2-year OS difference between patients with de novo distant metastasis and SCLN metastasis (P≤0.00071). The multivariate analysis demonstrated that SCLN metastasis was not associated with poorer survival. Higher radiation dose and lower pretreatment neutrophil-lymphocyte ratio were independently associated with better OS. Conclusions: For patients with ESCC treated with definitive chemoradiation, SCLN metastasis was not independently associated with poorer survival. Curative treatment should be considered for these patients. Higher radiation dose and lower pretreatment neutrophil-lymphocyte ratio improved the treatment outcomes.