P1.102. A Study of Lymph Node Metastasis in cNo.104 Cases of Thoracic Esophageal Squamous Cell Carcinoma

Abstract

Esophageal Cancer: Management of Metastatic Cancer The JCOG1109 trial established docetaxel, cisplatin, and 5-fluorouracil (DCF) therapy as the standard preoperative treatment for locally advanced thoracic esophageal cancer, achieving improved local control. Subsequently, the JCOG1409 trial demonstrated the non-inferiority of thoracoscopic minimally invasive esophagectomy compared with open surgery, establishing minimally invasive surgery as the standard approach. However, clinical No.104 lymph node metastasis is classified as cM1 disease and is generally considered beyond the standard surgical indication. Consequently, its optimal treatment strategy and oncological outcomes remain controversial. We retrospectively reviewed 58 patients with thoracic esophageal squamous cell carcinoma and clinical No.104 lymph node metastasis (excluding salvage cases) who underwent minimally invasive esophagectomy between January 2018 and February 2023. Median age was 68 years; male/female: 49/9; PS 0/1: 44/14; Ut/Mt/Lt: 18/32/8; cT1/2/3/4: 6/1/42/6; cN0/1/2/3: 3/14/25/12.Preoperative chemotherapy was administered in 51 cases (88.0%). R0 resection was achieved in 93.1% of cases, and pNo.104 metastasis was observed in 25cases (43.1%). The 3-year overall survival (OS) rate was 57.5% overall. There was no significant difference in pNo.104R metastasis status (-/+: 44.6%/37.5%; p=0.55), but a significant difference was observed in pNo.104L metastasis status (-/+: 61.5%/44.0%; p=0.04). Similarly, the 2-year RFS was 42.0%. While no significant difference was observed for pNo.104R metastasis-/+: 44.6/37.5% (p=0.55), a significant difference was noted for pNo.104L metastasis-/+: 49.6/0.0% (p=0.003). Acceptable oncological outcomes may be achieved in selected patients with clinical No.104 lymph node metastasis undergoing minimally invasive esophagectomy. However, pathological left-sided No.104 metastasis is associated with significantly worse survival and higher recurrence rates, suggesting distinct biological behavior and the potential need for tailored postoperative therapeutic strategies.