The cervical and celiac
lymph node metastases are defined as distant
metastasis (Mlym) from thoracic esophageal
carcinoma by TNM (primary
tumor, regional lymph nodes, and distant
metastasis) classification. The prognostic factors, however, of such distant node
metastases are not fully understood. Of 85 patients with node-positive thoracic esophageal
carcinoma who were treated with the same modalities of treatment, 31 (37%) had Mlym. Prognostic factors for long-term survival were analyzed by univariate and multivariate analyzes. Three patients are alive and free of
cancer, and two patients survived over 5 years. Fifteen patients died of recurrent
esophageal cancer and 11 patients succumbed to causes unrelated to
esophageal cancer. Two patients with a single Mlym died without recurrence of
esophageal cancer at 1.4 years and after more than 5 years, respectively. The 1-, 2-, 3-, and 5-year overall survival rates of all 31 patients were 64.5%, 24.8%, 17.0%, and 12.8%, respectively. The factors influencing survival rate were depth of invasion (pT1,2 vs. pT3,4) and metastatic lymph node ratio (< or =0.104 vs. > or =0.105). The survival rates were not influenced by number of
lymph node metastasis, number of Mlym, or by metastatic lymph node ratio of Mlym. Among those two significant variables verified by univariate analysis, independent prognostic factor for survival determined by multivariate analysis was the metastatic lymph node ratio (risk ratio = 3.4, p = 0.0345). The results of this study indicate that a significant number of patients can be cured of esophageal
carcinoma by extensive resection along with extended
lymph node dissection even when the disease metastasizes to distant nodes.