Clinical Importance of Supraclavicular Lymph Node Metastasis After Neoadjuvant Chemotherapy for Esophageal Squamous Cell Carcinoma

Objective: To examine the clinical implications of supraclavicular (SC) lymph node (LN) metastasis in patients with esophageal squamous cell carcinoma (ESCC) who receive neoadjuvant chemotherapy, followed by surgery. Background: Indications for surgery for esophageal cancer often do not include cases with SCLN metastasis because the latter is considered distant metastasis. However, neaodjuvant therapy may change the clinical importance of SCLN metastasis. Methods: In 323 patients with ESCC who underwent neoadjuvant chemotherapy, the correlations between SCLN metastasis and clinicopathological factors including survival were examined. Results: The incidence of SCLN metastasis was 17.6% before therapy and 14.6% after therapy. In patients with SCLN metastasis at baseline, the incidence of posttherapy SCLN metastasis was significantly lower in major responders to chemotherapy than in minor responders. The total number of metastatic LNs was significantly higher in patients with posttherapy SCLN metastasis than in patients with metastatic LN but no SCLN (10.9 vs 3.9; P 0.001). Survival was shorter in patients with SCLN metastasis than in those with metastatic LN without SCLN (3-year overall survival rate; 20.1% vs 45.7%; P = 0.003). However, there was no significant difference in survival between patients with SCLN metastasis before but not after therapy and patients without SCLN metastasis before and after chemotherapy (3-year overall survival rate; 64.9% vs 58.2%; P = 0.2071). Conclusions: This study showed that SCLN metastasis in ESCC reflects the number of metastatic LNs. SCLN metastasis should not be considered as contraindication to curative surgery in multimodal treatment of ESCC because preoperative treatment can change SC nodal status.