Lymph node metastasis patterns and survival in patients with esophageal squamous cell carcinoma undergoing McKeown esophagectomy: a retrospective cohort study.
6 affiliations
- 1Department of Anesthesiology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.
- 2Department of Thoracic Surgery, Anyang Tumor Hospital, Anyang, China.
- 3Department of Cardiac Surgery, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.
- 4The First School of Clinical Medicine, Guangzhou Medical University, Guangzhou, China.
- 5Department of Thoracic Surgery and Oncology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.
- 6State Key Laboratory of Respiratory Disease & National Clinical Research Center for Respiratory Disease, Guangzhou, China.
Abstract
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. 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. 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). 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.
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BibTeX
@article{liu2026lymph,
title = {{Lymph node metastasis patterns and survival in patients with esophageal squamous cell carcinoma undergoing McKeown esophagectomy: a retrospective cohort study.}},
author = {Hui Liu and Weimin Zhang and Ailing Zhang and Ling Zhang and Zishan Huang and Shiwei Nie and Xudong Wei and Jun Liu and Xiaodong Zheng},
journal = {Journal of thoracic disease},
year = {2026},
month = sep,
doi = {10.21037/jtd-2026-1701},
url = {https://europepmc.org/article/MED/42996965},
note = {CC BY-NC-ND},
}
RIS
TY - JOUR
TI - Lymph node metastasis patterns and survival in patients with esophageal squamous cell carcinoma undergoing McKeown esophagectomy: a retrospective cohort study.
AU - Hui Liu
AU - Weimin Zhang
AU - Ailing Zhang
AU - Ling Zhang
AU - Zishan Huang
AU - Shiwei Nie
AU - Xudong Wei
AU - Jun Liu
AU - Xiaodong Zheng
PY - 2026
DA - 2026/09/28
JO - Journal of thoracic disease
DO - 10.21037/jtd-2026-1701
UR - https://europepmc.org/article/MED/42996965
AB - 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. 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. 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). 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.
SN - 2072-1439
SN - 2077-6624
ER -