Prognostic Value of Subcarinal Lymph Node Metastasis in Patients with Esophageal SCC

Esophageal cancer (EC) is the eighth most common cancer worldwide, with 482,000 new cases estimated in 2008, and the sixth most common cause of death from cancer with 407,000 deaths (Ferlay et al., 2010). In China, EC is the fourth most common cause of mortality and is frequently located in the thorax, while 95% of EC is pathologically diagnosed as squamous cell carcinoma (Ferlay et al., 2010; Mao et al., 2011). Although advances have occurred in the multidisciplinary treatment, surgical resection remains the modality of choice. Lymph node (LN) metastasis is the single most important prognostic factor in EC (Ferguson et al., 1997; Mao et al., 2011). Accurate N staging of EC is crucial, as it will impact on choice of management, the need for chemoradiotherapy, choice of surgical approach, and aid in predicting prognosis (DeMeester et al., 2006; Kunisaka et al., 2010; Kayani et al., 2011; Mirinezhad et al., 2012). Many scholars believed that the prognosis in patients with EC depended on the number, but not the site, of metastatic LNs after curative esophagectomy (Greenstein et al., 2008; Peyre et al., 2008). Moreover, the 7th edition of the American Joint Committee Cancer Staging Manual