Survival in esophageal cancer with non-regional lymphadenopathy: A propensity score matched analysis

Survival among esophageal cancer patients with stage IV non-regional lymphadenopathy treated with neoadjuvant therapy and surgical resection is not well described. This study aimed to compare the survival outcomes of patients with non-regional lymphadenopathy with a propensity matched cohort of patients with loco-regional disease. A retrospective cohort analysis of a prospectively maintained database from a regional upper gastrointestinal cancer network in Quebec, Canada was performed. From 01/2010 until 12/2022, patients with radiologically suspicious non-regional retroperitoneal or supraclavicular lymphadenopathy were identified. Using 1:1 propensity score matching, a control group without non-regional disease was created. Of the 1235 patients identified, 39 met the inclusion criteria and were allocated to the study group of whom 35/39 (89%) had adenocarcinoma. Retroperitoneal and supraclavicular lymphadenopathy occurred in 26/39 (67%) and 13/39 (33%). Thirty-four received neoadjuvant chemotherapy (87%) and 5/39 (13%) chemoradiotherapy. Following resection, ypN0 of non-regional lymph node stations occurred in 21/39 (54%). When comparing the study group with a matched non-Stage IV control group, median overall survival was similar in patients with retroperitoneal lymphadenopathy (21 months, 95% CI 8-21 vs 27.0, 95% CI 13-41 p=0.262) but not with supraclavicular disease (13 months, 95% CI 8-18,p=0.039). Median follow up was 40.1 months (95% CI 1-83) and 70.0 (95% CI 33-106) for the study and control groups. Compared to a matched cohort of patients with similar disease burden but not stage IV disease, retroperitoneal lymphadenopathy did not negatively affect survival outcomes. Multimodal curative intent therapy may be appropriate in select cases.