237. THE PROGNOSTIC VALUE OF NODAL SKIP METASTASIS IN PATIENTS WITH ESOPHAGEAL CANCER

Abstract Background Nodal skip metastasis (NSM), a common form of lymphatic spread in esophageal cancer (EC), refers to metastatic involvement of distant lymph nodes (LNs) without prior engagement of adjacent LNs. Previous studies examining the association between NSM and survival outcomes in EC patients have yielded inconsistent and even contradictory results. This systematic review and meta-analysis aim to assess the prognostic value of NSM and summarize NSM definitions used in prior studies. Methods Four databases were employed for this meta-analysis. The relationship between NSM and overall survival (OS) was assessed using pooled hazard ratios (HRs) and their 95% confidence intervals (CIs). Sensitivity analysis and funnel plots were utilized to evaluate publication bias. Results This meta-analysis incorporated nine studies, and the pooled results revealed no significant association between NSM and OS (HR = 0.99, 95% CI: 0.75–1.31; P = 0.951). Sub-group analyses based on histological features, method of lymphadenectomy, node staging system, and NSM definitions also failed to identify a significant association between NSM and OS. Conclusions Based on the available evidence, NSM cannot be considered a prognostic factor for EC patients. Future studies examining the prognostic value of NSM should focus on employing three-field lymphadenectomy with an adequate number of harvested LNs. NSM definitions based on lymph node station and anatomical compartment could both serve as feasible classifications for EC.