The prognostic significance of subcarinal lymph node dissection in esophagectomy for middle and lower thoracic squamous cell carcinoma.

Abstract

Objectives: This retrospective study assesses the prognostic value of subcarinal lymph node dissection (SCLND) in esophageal squamous cell carcinoma (ESCC) of the middle and lower thoracic regions.

Methods: The study, conducted at the Fourth Hospital of Hebei Medical University, included 1587 patients with ESCC who underwent radical resection from 2008 to 2014, comprising 204 patients in the non-SCLND group and 1383 patients in the SCLND group. After applying inverse probability of treatment weighting (IPTW) to adjust for confounders, Kaplan-Meier curves, log-rank tests, and Cox regression were used for survival analysis, performed using R.

Results: SCLN metastasis was found in 9.8% of patients. Factors influencing metastasis included pathologic T stage (P < 0.001) and N stage (P < 0.001). SCLN metastasis significantly affected overall survival, with 5-year rates of 49.0% for non-metastatic versus 7.0% for metastatic patients. SCLND improved long-term survival for T3-T4a stage patients but not for T1-T2.

Conclusions: Despite a low SCLN metastasis rate, its presence significantly worsens prognosis. SCLND does not significantly improve long-term survival in patients with pathologic T1-T2 tumors, but it may confer a survival benefit in T3-T4a stage disease, supporting individualized surgical decisions regarding lymph node dissection.