Background Although most studies proved that thoracic esophageal cancer surgery with supraclavicular lymph nodes (SCLNs) metastasis could benefit, less than 30% of the 5-year survival rate remained controversy on its surgical treatment. In this study, we aimed to analyze the prognosis of SCLNs on the different segments of thoracic esophageal cancer, which will supply a reference for the treatment of this disease. Methods Retrospectively collected the clinical data of 163 patients with thoracic esophageal squamous cancer (ESCC) and compared the effects of SCLNs on prognosis in different segments. Results Patients with SCLNs metastasis had a worse prognosis than the negative group (P<0.001). In the upper thoracic group, there was no significant difference in OS between SCLNs positive group and negative group (P=0.077); however, in the middle and lower thoracic group, SCLNs positive group had a worse prognosis than the negative group (P<0.001) and lymph nodes positive in other sites (except for SCLNs) (P=0.039). Multivariate analysis found that SCLNs metastasis was an independent risk factor affecting the prognosis of ESCC in the middle and lower thoracic segments (P=0.007). Conclusions For patients with upper thoracic ESCC, SCLNs appear to be regional nodes. For the middle and lower thoracic ESCC, SCLNs should be defined as distant metastasis, and neoadjuvant therapy first may be an available therapy.

/pdf/clinical-significance-and-prognosis-of-supraclavicular-lymph-5cbovcz9uv.pdf

Clinical significance and prognosis of supraclavicular lymph node metastasis in patients with thoracic esophageal cancer

Background: To evaluate the clinical characteristics and prognostic factors of esophageal carcinoma (EC) with multiple primary carcinomas (ECWMPC). Methods: Clinical and survival data of 268 ECWMPC patients with two different primary carcinomas and 9,101 individual EC patients taken from hospital records dating from January 1996 to December 2012 were analyzed retrospectively. Results: There were a total of 11,066 EC patients treated over this period of which 330 patients met the diagnostic criteria of ECWMPC. Two hundred and sixty-eight patients who had two different primary carcinomas and survival data were recruited in this analysis. The median age of the first carcinoma occurrence was 59 (31 to 85) years old, and the median age of the second carcinoma occurrence was 62 (32 to 86) years old, with a male to female ratio of 6:1. The predilection sites were located in the head and neck, followed by the gastric-esophageal junction. For the subgroup of synchronous ECWMPC (S-ECWMPC) and metachronous ECWMPC (M-ECWMPC), head and neck remain the popular site of S-ECWMPC but cardiac became the top of the M-ECWMPC. More breast and colon rectum disease were found in S-ECWMPC patients. The ECWMPC patients had a significantly lower median survival time (MST) and 1, 3, and 5 years overall survival (OS) than the single EC patients [12.4 months and 51.8%, 21.9%, 14.7% vs . 17.0 months and 59.4%, 31.3%, and 23.9% (P vs . 13.9 months and 56.2%, 25.6%, 19.5% (P=0.001)]. Within the S-ECWMPC group, patients who only received radiotherapy and/or chemotherapy (RoC) (n=52) had a shorter/poorer survival time (MST and 1, 3, and 5 years OS are 9.8 months, 44.2%, 8.7%, 3.2%) compared to patients who received surgery (n=43) (MST and 1, 3, and 5 years OS are 16.4 months, 64.8%, 33.3%, 18.6%) (P=0.031), but a longer survival time compared to patients who had no treatment (n=20) (MST and 1, 3, and 5 years OS are 4.1 months, 10.0%, 5.0%, and 0%)(P=0.002). Within the M-ECWMPC group, patients who had received surgery (n=103) had a longer survival time than patients who had only received RoC (n=38) (MST 22.5 vs . 10.6 months, P=0.026). Among the 103 M-ECWMPC patients who had received surgery, 55 of them had an esophagus resection, whose OS was similar to those 3,633 operated EC patients (MST 31 months vs . 30 months, P=0.905). Within the M-ECWMPC group, patients with greater than 3 years interval time of diagnosis (ITD) had a better prognosis compared to patients with less than 3 years ITD (MST 24.8 vs . 13.2 months, P=0.021) There is no statistical difference in the prognosis between M-ECWMPC patients and Single EC patients (P=0.585).
 Conclusions: ECWMPC is not rare among EC patients. There is more cardiac in the M-ECWMPC patients and more Breast and Colon rectum disease were found in S-ECWMPC patients. Prognosis of M-ECWMPC patients was better than that of the S-ECWMPC patients. M-ECWMPC patients with a more than 3 years ITD had a better prognosis. In M-ECWMPC patients, esophageal surgery can acquire better survival benefits than other treatments. Surgery is highly recommended for ECWMPC patients.

/pdf/clinical-characteristics-and-prognostic-factors-of-200ivzxvt2.pdf

Clinical characteristics and prognostic factors of esophageal carcinoma associated with multiple primary carcinomas: a report of 268 cases

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Clinical characteristics and prognostic factors of esophageal carcinoma associated with multiple primary carcinomas: a report of 268 cases