Lymph Node Metastasis Pattern and Influencing Factors in Esophageal Squamous Cell Carcinoma

ABSTRACT Objectives To investigate the lymph node metastasis (LNM) pattern of esophageal squamous cell carcinoma (ESCC) and identify factors associated with LNM: Methods A retrospective study was conducted including 388 patients with ESCC who underwent curative resection at the First Affiliated Hospital of Nanjing Medical University between January 2020 and December 2022. Clinicopathological characteristics and lymph node metastasis patterns were analyzed. Univariate and multivariate analyses were performed to identify factors associated with LNM. Results Among the 388 patients, 144 (37.11%) had lymph node metastasis. The total number of dissected lymph nodes was 8546, with 341 positive nodes, yielding an LNM degree of 3.99%. Upper thoracic ESCC was more likely to metastasize to upper right paratracheal lymph nodes, while lower thoracic ESCC showed a higher rate of paracardial lymph node metastasis. Tumor differentiation, tumor size, invasion depth, age, and intravascular tumor thrombus were associated with LNM. Multivariate logistic regression analysis revealed that tumor diameter ≥ 3 cm (OR = 2.485, 95% CI 1.483–4.165, p = 0.001) and intravascular tumor thrombus (OR = 7.123, 95% CI 3.101–16.362, p < 0.001) were independent risk factors. Conclusions Upper esophageal SCC tends to metastasize to upper mediastinal lymph nodes, whereas abdominal and paracardial lymph node metastasis is more common in lower esophageal SCC. Tumor size and intravascular tumor thrombus are independent risk factors for lymph node metastasis.