LAUSR

Clinical diagnosis of lymph node metastasis has a great significance particularly in cT1 or cT2 esophageal cancer patients, since their clinical “N” diagnosis determines the treatment strategy according to the Esophageal cancer practice guidelines 2017 edited by the Japan Esophageal Society. Then clinically node-negative but pathologically node-positive status could potentially have negative impact on survival outcome. The purpose of this study is to see the impact of clinical node diagnosis. Esophageal squamous cell carcinoma patients diagnosed as cT1N0 or cT2N0 who underwent radical esophagectomy from 2003 to 2017 were enrolled retrospectively. Clinically node-positive was defined as any of the followings; 1) 10 mm or more longest diameter, 2) 8 mm or more longest diameter and round or irregular shaped, 3) 5 mm or more longest diameter and FDG uptake on PET-CT scan. Survival curves with Kaplan–Meier method were plotted by the pathological N stage and examined by the log rank test. Totally 203 patients were enrolled in this study. There were 159(78%)/36(18%)/8(4%)/0(0%) pN0/pN1/pN2/pN3 patients, respectively. There was no significant survival difference between pN0 and pN1 patients (p = 0.9). But pN2 patients had worse survival than pN0 patients (p = 0.0037). There was no negative survival impact of two or less clinically negative but pathologically positive nodes. This might suggest that clinical node diagnosis should be assessed carefully enough in order to have as less number of clinically negative but pathologically positive nodes as possible. Further investigation is needed for those having three or more clinically negative but pathologically positive nodes.