Prognostic value of thoracic recurrent nerve nodal involvement in esophageal squamous cell carcinoma

Background: The determination of a simple and reliable prognostic factor that allows identification of patients at high risk of early cancer recurrence and subsequent death after resection of esophageal carcinoma should contribute to more accurate management of patients suffering from this disease. Study Design: The aim of this study was to assess the prognostic value of thoracic recurrent nerve nodal involvement after curative resection of esophageal squamous cell carcinoma. The prognostic importance of gender, age, tumor penetration, and extent of lymph node involvement was evaluated in 55 patients after curative resection of esophageal squamous cell carcinoma. Results: Thirty-four of 55 patients (62%) had nodal metastases and 10 of 55 (18%) had thoracic recurrent nerve nodes involved. The median overall survival was 28 months. By univariate analysis, survival was higher in association with the absence of adventitial invasion (p = 0.04), of nodal involvement (p = 0.03), and of thoracic recurrent nerve nodal involvement (p = 0.0001). In a Cox proportional hazards regression model, thoracic recurrent nerve nodal involvement appeared the strongest predictive factor (adjusted hazard ratio 8.4 (3.0-23.7)). Conclusions: Assessment of thoracic recurrent nerve nodes is appropriate to identify patients who are at high risk of disease-related death after surgical resection. (C) 1997 by the American College of Surgeons.