Clinical Analysis Of Radiotherapy For Patients With Esophageal Carcinoma With Supraclavicular Lymph Node Metastasis

Objective: To analyze the factors affecting the prognosis of radiotherapy for esophageal carcinoma with supraclavicular lymph node metastasis, and to investigate the influence of supraclavicular lymph node metastasis on UICC-TNM classification of esophageal carcinoma.Method: Patients of esophageal carcinoma with supraclavicular lymph node metastasis were collected from January 2005 to December 2008. There were 152 patients entered into this retrospective study. 95 patients'primary tumor received radiotherapy and 57 received surgery. 81 patients were found supraclavicular lymph nodes metastasis after the treatment of primary esophageal carcinoma, and 71 patients were found the metastasis when they were diagnosed. 141 patients with supraclavicular lymph node metastasis received radiotherapy and 11 patients didn't.Result: 1. After the radiotherapy of supraclavicular lymph node, CR, PR, NC and PD were achieved in 74, 59, 5 and 3 patients. The diameter of supraclavicular metastatic lymph node (P=0.000), and the dose of radiation to supraclavicular lymph node (P=0.023) showed the statistical significance for the result of CR after radiotherapy. 2. There were 112 patients died within the follow-up period, and 40 patients survived. The 1-, 2- and 3-year survival rates of the entire cohort were 69.1%, 37.4% and 24.0%. (1) The 1-, 2- and 3-year survival rates of the patients younger than 60 years and older than 60 years were 76.5%, 44.3%, 28.7% and 60.6%, 29.6%, 18.7% (P=0.029). (2) The 1-, 2- and 3-year survival rates of patients with metastasis of supraclavicular lymph nodes after primary esophageal carcinoma had been treated and with the metastasis when they were diagnosed were 80.2%, 45.5%, 26.7% and 56.3%, 28.1%, 21.7% (P=0.028). The 1-, 2- and 3-year survival rates after supraclavicular lymph nodes metastasis of the two groups were 47.5%, 23.9%, 14.3% and 56.3%, 28.1%, 21.7% (P=0.204). (3) The 1-, 2- and 3-year survival rates after supraclavicular lymph nodes metastasis for one-side and both sides were 57.5%, 27.1%, 18.0% and 26.7%, 13.3%, 13.3% (P=0.026). (4) There were 48 patients with visceral metastasis when or after the supraclavicular lymph nodes metastasis and 104 patients were not. The 1-, 2- and 3-year survival rates of the two groups were 62.5%, 17.5%, 5.8% and 72.1%, 7.0%, 32.9% respectively (P=0.000). (5) The 1-, 2- and 3-year survival rates after supraclavicular lymph nodes metastasis of patients with the dose of supraclavicular lymph nodes more than 60Gy and less then 60Gy were 69.4%, 42.2%, 33.3% and 14.7%, 0%, 0% (P=0.000). The 60~70Gy group and more than 70Gy group were 61.9%, 30.8%, 26.8% and 59.4%, 29.9%, 9.0% (P=0.499). The 1-, 2- and 3-year survival rates after supraclavicular lymph nodes metastasis of patients with supraclavicular preventive radiation and without were 56.0%, 36.7%, 15.7% and 63.8%, 38.9%, 32.6% (P=0.859). (6) There were 60 patients of esophageal carcinoma with supraclavicular lymph node metastasis received radiotherapy combined with chemotherapy and 81 cases were not. The 1-, 2- and 3-year survival rates after supraclavicular lymph nodes metastasis of the two groups were 67.0%, 41.5%, 35.6% and 52.9%, 32.6%, 23.3% (P=0.189). 3 Multivariate analysis showed that age, the time of supraclavicular lymph nodes enlargement with primary esophageal carcinoma, one-side supraclavicular lymph node metastasis or both sides, the therapeutic effect of enlargement lymph nodes and visceral metastasis were independent factors for the survival (P=0.009, 0.021, 0.002, 0.001, 0.008). 4. There were 39 patients with regional lymph node metastasis (N1 group) and 71 patients with supraclavicular lymph node metastasis (M1 group) when the primary esophageal carcinoma were diagnosed. The 1-, 2- and 3-year survival rates of the two groups were 82.1%, 54.1%, 31.0% and 56.3%, 28.1%, 1.7%(P=0.041). M1 patients were divided into M1a group (upper esophageal carcinoma with supraclavicular lymph node metastasis) and M1b group (middle and lower esophageal carcinoma with supraclavicular lymph node metastasis). The 1-, 2- and 3-year survival rates of the two groups were 60.0%, 27.3%, 27.3% and 54.9%, 28.7%, 19.0% (P=0.930).Conclusions: 1. The patients of esophageal carcinoma with supraclavicular lymph node metastasis can benefit from radiotherapy. 2. The diameter of supraclavicular metastasis lymph node (P=0.000), and the dose of radiation of supraclavicular lymph node (P=0.023) showed influence on the result of CR after radiotherapy. 3. Multivariate analysis showed that age, the time of supraclavicular lymph nodes enlargement with primary esophageal carcinoma, one-side supraclavicular lymph node metastasis or both sides, the therapeutic effect of enlargement lymph nodes and visceral metastasis were independent factors for the survival (P=0.009, 0.021, 0.002, 0.001, 0.008). 4. In this research, the suitable dose of supraclavicular lymph node was 60~70Gy. Preventive irradiation of contralateral supraclavicular region showed no advantage in prognosis. 5. It was different among supraclavicular lymph node metastasis, regional lymph node metastasis and visceral metastasis for survival. Whether the supraclavicular lymph node enlargement should be considered as distant metastasis needs a further research. There was no difference among the survival rates of upper, middle and lower esophageal carcinoma with supraclavicular lymph node metastasis.