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Paratracheal Lymph Node Metastasis Is Associated With Cervical Lymph Node Metastasis in Patients With Thoracic Esophageal Squamous Cell Carcinoma

From the Department of Surgery and Surgical Basic Science, Graduate School of Medicine, Kyoto University, Kyoto, Japan.

Correspondence: Address correspondence and reprint requests to: Yutaka Shimada, MD, FACS, Department of Surgery and Surgical Basic Science, Graduate School of Medicine, Kyoto University, Kawara-cho 54, Shogoin, Sakyo-ku, Kyoto, 606-8507, Japan; Fax: 81-75-751-4390; E-mail: shimada{at}kuhp.kyoto-u.ac.jp

Background: We determined which lymph node metastases were associated with cervical lymph node metastases of thoracic esophageal squamous cell carcinoma.

Methods: A total of 6464 lymph nodes derived from 155 consecutive patients with thoracic esophageal squamous cell carcinoma were stained by immunohistochemistry (antibody: AE1/AE3). Lymph node metastases were mapped according to the mapping scheme of the American Thoracic Society, as modified by Casson et al. (Ann Thorac Surg 1994;58:1569–70). Patients were divided into two groups: those with and without cervical lymph node metastasis (CLNM). Mapping data were examined by uni- and multivariate analysis.

Results: Hematoxylin and eosin–positive and AE1/AE3-positive lymph node metastases were found in 59% and 77% of patients, respectively. Twenty-one (55%) of 38 patients in the CLNM(+) group and 30 (26%) of 117 patients in the CLNM(-) group had AE1/AE3-positive lymph node metastasis in the thoracic paratracheal lymph node. Paratracheal lymph node metastasis is only one independent factor for (CLNM), whereas upper thoracic paraesophageal lymph node and pulmonal hilar lymph node status were also significant in univariate analysis. Three (43%) of seven patients with cervical jumping metastasis from the thoracic esophagus had micrometastasis in the paratracheal lymph node.

Conclusions: The paratracheal lymph node is most associated with (CLNM) of thoracic esophageal squamous cell carcinoma.

Key Words: Paratracheal lymph node • Cervical lymph node • Thoracic esophageal squamous cell carcinoma • Immunohistochemistry

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