Zhenyang Xu, Xiaolei Zhu, Jie Jiang, Guojun Geng, Guanzhi Ye
NSM was associated with more favorable survival in the unmatched cohort, but this association was not retained after PSM. These findings suggest that metastatic nodal burden, rather than the anatomical skip pattern itself, may play a more central role in postoperative prognosis among patients with node-positive T-ESCC.
BACKGROUND: The prognostic significance of nodal skip metastasis (NSM) in esophageal cancer remains unclear. This study aimed to investigate the prognostic significance of NSM in patients with thoracic esophageal squamous cell carcinoma (T-ESCC) who had positive lymph nodes following esophagectomy and identify factors associated with its occurrence.
METHODS: A retrospective analysis was conducted on patients with T-ESCC who underwent esophagectomy between December 2020 and December 2024. Patients were classified into the NSM group and the non-nodal skip metastasis (NNSM) group based on postoperative lymph node patterns. Propensity score matching (PSM) was performed to account for baseline confounders and mitigate selection bias among patients. Risk factors for NSM were examined using Chi-squared test or Fisher exact test, followed by logistic binary regression. The influence of NSM on overall survival (OS) and disease-free survival (DFS) was evaluated using the Kaplan-Meier method and univariate and multivariate Cox proportional hazards models.
RESULTS: A total of 137 patients with T-ESCC were included, with an NSM incidence of 28.5%. Logistic regression analysis showed that N stage (P=0.003) was an independent risk factor for NSM. Patients in the NSM group had significantly higher 1-, 2-, and 3-year OS (P=0.041) and DFS (P=0.045) rates than those in the NNSM group. PSM produced 30 matched pairs, revealing no significant differences in OS (P=0.69) or DFS (P=0.65). Cox proportional hazards analyses indicated that N stage independently predicted OS (P=0.003) and DFS (P=0.001), whereas NSM was not an independent predictor of OS (P=0.39) and DFS (P=0.054).
CONCLUSIONS: NSM was associated with more favorable survival in the unmatched cohort, but this association was not retained after PSM. These findings suggest that metastatic nodal burden, rather than the anatomical skip pattern itself, may play a more central role in postoperative prognosis among patients with node-positive T-ESCC.