Pretracheal (No.106pre) lymph node metastasis in esophageal carcinoma: A sign of widespread disease progression, but potentially treatable as oligometastatic disease through neoadjuvant chemotherapy followed by surgery - A multicenter cohort study.

BACKGROUND: Oligometastatic disease in esophageal carcinoma includes metastases to distant organs and extra-regional lymph nodes. Pretracheal lymph node metastasis (No. 106pre in the Japanese classification) is classified as an M1 lymph node metastasis and has a poor prognosis. However, documentation is limited and has often focused on heterogeneous cohorts from earlier times. The present study examines the outcomes of pretracheal lymph node resection in modern neoadjuvant therapy followed by surgery.

METHODS: This multicenter retrospective cohort study, conducted at two cancer centers in Japan, included esophageal carcinoma patients with clinical pretracheal lymph node metastasis who underwent neoadjuvant chemotherapy followed by esophagectomy. Short-term and long-term outcomes were analyzed.

RESULTS: In total, 110 patients were included, of whom 94 were negative, and 16 were positive for pathological pretracheal lymph node metastasis (p106pre(-) and p106pre(+)). The 106pre(+) group exhibited more advanced disease and a higher average number of metastatic lymph nodes (10.0). The 3-year overall survival rate was 66.6 % in the p106pre(-) group and 29.9 % in the p106pre(+) group, significantly poorer but not as poor as previously reported. Multivariate analysis identified ypN3 as the most potent independent prognostic factor, while pathological 106pre metastasis was not an independent prognostic factor.

CONCLUSIONS: In this multicenter study, patients with esophageal carcinoma with clinical pretracheal lymph node metastasis who underwent esophagectomy with lymph node resection after neoadjuvant chemotherapy had better outcomes than those previously reported. Some patients achieved long-term survival, suggesting that pretracheal lymph node metastasis can be considered oligometastatic disease.