Long-term survivors of esophageal carcinoma with distant lymph node metastasis.

BACKGROUND/AIMS: Clinical extra-regional lymph node metastasis, M1 lymph node metastasis (M1 LYM), has been recognized as a far advanced condition in esophageal cancer. However, some patients with M1 LYM survive long-term. The purpose of this study was to identify the clinicopathological features of those patients with M1 LYM achieving long-term survival. METHODOLOGY: Between 2002 and 2008, 31 patients with squamous cell carcinoma of the thoracic esophagus with M1 LYM were treated at our institution. Of the 31 patients, four survived for more than three years. These four patients were examined retrospectively. RESULTS: Cervical lymph node metastasis was the cause of M1 LYM and no regional nodal metastasis was detected in any of the four patients. Primary lesions were non-T4 and located at the middle or lower thoracic esophagus in these patients. Two patients underwent radical esophagectomy with three-field lymphadenectomy and complete resection was confirmed by pathological examination. The other two patients underwent definitive chemoradiotherapy and complete response was confirmed. Three patients are alive without recurrence but one, who underwent definitive CRT, died of local recurrence. CONCLUSION: Solitary metastasis localized at the cervical node might be targeted specifically in an effort to improve the prognosis of M1 LYM patients with esophageal cancer.