[A retrospective study on the therapeutic effect of neck dissection in patients with cervical esophageal squamous cell carcinoma].

Abstract

Objective: To evaluate the surgical outcomes in cervical esophageal squamous cell carcinoma (CESCC) patients with cervical lymph node metastasis (CLNM). Methods: We performed a retrospective analysis on 180 CESCC patients (141 males, 39 females; with median age of 59 years, ranging in age from 24 to 76) who underwent surgical treatment at the Cancer Hospital, Chinese Academy of Medical Sciences from February 2001 to October 2023. Based on the regions of cervical lymph node metastasis, patients were divided into three groups: non-lymph node metastasis group, central compartment metastasis-only group, and a combined central and lateral cervical metastasis group. We aimed to compare the impact of cervical lymph node metastasis regions and different preoperative intervention regimens on survival outcomes. The 3-year and 5-year overall survival (OS) rates were estimated using the Kaplan-Meier method, and univariate and multivariate Cox regression analyses were performed to identify factors associated with prognosis. Results: Cervical lymph node dissection was performed in 123 patients with CLNM. Among all patients, 54 patients received preoperative chemotherapy, and 19 patients received preoperative chemotherapy combined with immunotherapy. The median OS in the entire cohort was 46 months, with 3-and 5-year OS rates of 58.04% and 42.02%, respectively. Patients without CLNM exhibited significant higher 5-year OS rate than those with CLNM (54.86% vs. 35.69%, χ²=7.29, P=0.007). No significant difference in 5-year OS rate was observed between the central neck lymph node metastasis-only group (54 patients) and the combined central and lateral neck lymph node metastasis group (69 patients) (35.98% vs. 35.36%, χ²=0.17, P=0.676). Preoperative chemotherapy and chemoimmunotherapy significantly reduced the mortality risk (HR=0.61 and 0.12, respectively; both P<0.05). Regarding the 3-year OS rate, there was a significant difference among the chemoimmunotherapy group (90.91%), chemotherapy-only (65.89%) and no-preoperative chemotherapy (49.68%) groups (overall χ²=11.22, P=0.004). Compared with patients who did not receive radiotherapy, preoperative and postoperative radiotherapy were not associated with a significant reduction in mortality risk (both P>0.05). Conclusions: After cervical lymph node dissection, the surgical efficacy of lateral CLNM patients resembles that of patients with central CLNM. Preoperative chemoimmunotherapy significantly improves the OS rates of CESCC patients.