Abstract Topic Esophageal Cancer: Adjuvant and Neo-Adjuvant Therapies Background The clinical significance of supraclavicular lymph node (SCLN) involvement in esophageal cancer remains controversial. The role of surgery in managing patients with SCLN metastases remains uncertain. This study evaluates the prognostic outcomes of patients with SCLN-positive esophageal cancer who received either surgical or nonsurgical treatment, aiming to develop evidence-based management strategies for this subgroup. Methods A retrospective analysis was conducted on 309 patients with esophageal cancer who were diagnosed with metastatic SCLNs at baseline at our institution between January 2019 and April 2024. Among them, 200 underwent surgical resection and 109 received definitive nonsurgical treatment. Propensity score matching (PSM) was performed based on age, sex, laterality (unilateral or bilateral), biopsy findings, lymph node size, tumor location, histological subtype, and clinical T and N stages. After PSM, the perioperative and survival outcomes were compared between the two treatment cohorts. Results After PSM, 67 patients were included in each group. The baseline characteristics were well-balanced. The surgical group exhibited significantly improved OS compared with the non-surgical group (P = 0.013). These findings suggest benefit of surgical intervention in SCLN-positive patients. Multivariate analysis confirmed surgery as an independent predictor of lower mortality risk (HR = 0.46, P = 0.022). The histological subtype of esophageal adenocarcinoma was associated with poor prognosis (HR = 2.77, P = 0.045), while bilateral SCLNs showed favorable prognosis. Subgroup analysis showed notable location-specific differences: surgery provided the survival advantage in middle thoracic tumors (median OS not reached vs. 29.2 months) (P=0.019), a non-significant favorable trend in lower thoracic tumors (median OS not reached vs. 31.8 months) (P=0.343), and no benefit in EGJ tumors (16.7 vs. 19.1 months; P = 0.584). Conclusion Surgical resection may offer a survival benefit for patients with esophageal cancer and SCLN metastases, supporting its role in specific cases. Tumor location should also be recognized as a determinant in therapeutic decision, as the survival advantage conferred by surgical intervention is most prominently observed in patients with middle thoracic tumors.
Huang et al. (2026) studied this question.