Segment-specific patterns of regional lymph-node metastasis in primary small-cell carcinoma of the esophagus: A systematic review and meta-analysis

doi:10.5306/wjco.123094

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World Journal of Clinical Oncology

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2218-4333

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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

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Copyright: ©Author(s) 2026. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution-NonCommercial (CC BY-NC 4.0) license. No commercial re-use. See permissions. Published by Baishideng Publishing Group Inc.

World J Clin Oncol. Aug 24, 2026; 17(8): 123094
Published online Aug 24, 2026. doi: 10.5306/wjco.123094

Segment-specific patterns of regional lymph-node metastasis in primary small-cell carcinoma of the esophagus: A systematic review and meta-analysis

Ke-Xun Li, Jie Mao, Jian-Zhe Zhang, Zi-Long Qian, Yong-Tao Han, Xue-Feng Leng

Ke-Xun Li, Yong-Tao Han, Xue-Feng Leng, Department of Thoracic Surgery, Sichuan Clinical Research Center for Cancer, Sichuan Cancer Hospital and Institute, Sichuan Cancer Center, Affiliated Cancer Hospital of University of Electronic Science and Technology of China (Sichuan Cancer Hospital), Chengdu 610041, Sichuan Province, China

Jie Mao, Jian-Zhe Zhang, Zi-Long Qian, Department of Thoracic Surgery, Third Affiliated Hospital of Kunming Medical University (Yunnan Cancer Hospital, Yunnan Cancer Center), Kunming 650118, Yunnan Province, China

Co-first authors: Ke-Xun Li and Jie Mao.

Co-corresponding authors: Yong-Tao Han and Xue-Feng Leng.

Author contributions: Li KX and Leng XF contributed to writing-original draft, formal analysis, writing-review and editing, visualization, conceptualization; Li KX, Qian ZL, Zhang JZ, Han YT, and Mao J contributed to visualization, conceptualization, writing-review and editing; Li KX and Mao J have made crucial and indispensable contributions towards the completion of the project and thus qualified as the co-first authors of the paper; Han YT and Leng XF played important and indispensable roles in the manuscript preparation as the co-corresponding authors.

AI contribution statement: During preparation of this work, the authors used ChatGPT solely to improve sentence structure and language clarity. All AI-assisted output was reviewed, verified and edited by the authors, who take full responsibility for the final manuscript.

Supported by the International Cooperation Projects of the Science and Technology Department of Sichuan Province, No. 2026YFHZ0053; the Ministry of Industry and Information Technology (MIIT) “Open Competition (Jiebang Guashuai) Program” for AI Medical Device Innovation No. 2025-AISJK-01001; and The “Flagship” Department Project of Integrated Traditional Chinese and Western Medicine and Yunnan Provincial Department of Science and Technology-Kunming Medical University Special Projects, No. 202601AY07001-170 and No. 202601AY07001-179.

Conflict-of-interest statement: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.

Corresponding author: Xue-Feng Leng, MD, PhD, Department of Thoracic Surgery, Sichuan Clinical Research Center for Cancer, Sichuan Cancer Hospital and Institute, Sichuan Cancer Center, Affiliated Cancer Hospital of University of Electronic Science and Technology of China (Sichuan Cancer Hospital), Chengdu 610041, Sichuan Province, China. doc.leng@uestc.edu.cn

Received: May 8, 2026
Revised: July 1, 2026
Accepted: August 20, 2026
Published online: August 24, 2026
Processing time: 108 Days and 23.9 Hours

Abstract

BACKGROUND

Primary small-cell carcinoma of the esophagus (SCCE) is a rare, biologically aggressive malignancy with a marked propensity for lymphatic dissemination. We estimated the prevalence of pathologically confirmed lymph-node metastasis in surgically staged SCCE and mapped the available segment-specific evidence at the nodal-station level.

AIM

To estimate the patient-level prevalence of pathologic lymph-node metastasis in surgically staged SCCE and to map the available segment-specific evidence at the station level.

METHODS

We conducted a PRISMA-informed exploratory systematic review and meta-analysis of a deduplicated evidence set comprising 99 SCCE-related records. Records were classified as direct nodal-station evidence, cohort-level N-status or prognostic evidence, or contextual case-based/background evidence. Surgically staged cohorts reporting SCCE-specific pathologic nodal positivity, including the CHiSCEC multicenter preprint, were pooled using logit-transformed proportions and a random-effects model. Because station denominators, nodal maps, and reporting definitions were insufficiently compatible for station-by-segment pooling, station-level findings were summarized as an evidence map.

RESULTS

Four surgical cohorts with compatible pathologic nodal denominators included 579 patients, of whom 352 were node-positive. The pooled prevalence of pathologic lymph-node metastasis was 61.1% (95%CI: 51.4% to 70.0%; I² = 76.4%; τ² = 0.113), indicating frequent nodal involvement and substantial between-study heterogeneity.

CONCLUSION

SCCE is associated with a high regional nodal burden, with a pooled prevalence of pathologic nodal metastasis of approximately 61%. Available station-level evidence suggests predominant recurrent laryngeal nerve and upper mediastinal involvement in upper thoracic SCCE, bidirectional spread in middle thoracic SCCE, and predominant perigastric and abdominal involvement in lower thoracic SCCE.

Keywords: Small-cell carcinoma of the esophagus; Lymph-node metastasis; Nodal stations; Systematic review

Core Tip: In small-cell carcinoma of the esophagus (SCCE), lymph-node metastasis is common and anatomically widespread rather than confined to peritumoral stations. Across four surgical cohorts, the pooled prevalence of pathologic nodal metastasis was 61.1%, with a consistent node-level metastatic ratio of about 11%-13%. Station-level evidence shows segment-specific but bidirectional spread involving cervical, mediastinal, and abdominal compartments, with frequent recurrent laryngeal nerve and perigastric node involvement and non-negligible skip metastasis. These findings highlight that SCCE should be understood as a highly lymphotropic disease and support broader, segment-adapted nodal assessment and clinical target-volume design rather than limited local field assumptions.