Metastasis Of Recurrent Laryngeal Nerve Lymph Nodes As A Predictor Of Cervical Lymph Node Metastasis In Esophageal Squamous Cell Carcinoma:A Retrospective Study

Objective: The prognosis of esophageal squamous cell carcinoma(ESCC)patients with cervical lymph node(CLN)metastasis is poor.However,there is no unified standard to determine which patients should undergo CLN dissection.The purpose of this study was to create a nomogram of pretreatment clinical parameters,including recurrent laryngeal nerve lymph node(RLN LN)metastasis,that predict CLN metastasis to identify patients in whom CLN dissection is necessary.Methods: We retrospectively collected the postoperative pathological results of 135 patients with ESCC who underwent three-field lymphadenectomy(3FL)at the Sichuan Cancer Hospital,Chengdu,China.between January 2010 and January 2016.Independent risk factors for CLN metastasis were obtained by logistic regression analysis,and a nomogram was constructed to predict the risk of CLN metastasis based on pretreatment clinical parameters.The nomogram was validated to assess its clinical utility.The effect of CLN status on survival was analyzed.Results: Seventy-two patients(53.3%)had RLN LN metastasis and 49(36.3%)had CLN metastasis.Of the 72 patients with RLN LN metastasis,32(44.4%)also had CLN metastasis(P = 0.035).Multivariate analysis showed that bilateral RLN LN metastasis was an independent risk factor for CLN metastasis(P = 0.029).The prediction model,which included bilateral RLN LN metastasis,upper thoracic tumor location,and lymphovascular invasion,showed good prediction accuracy(concordance index 0.722).Cox regression analysis showed that patients with CLN metastasis had poorer survival than those without CLN metastasis(P < 0.001).Subgroup analysis showed that 60%(81/135)of patients had upper thoracic ESCC,and 46.9% of these patients(38/81)had CLN metastasis.Conclusion: Bilateral RLN LN metastasis in patients with upper thoracic ESCC can be used as a predictor of CLN metastasis.