The number of metastatic lymph nodes and the ratio between metastatic and examined lymph nodes are independent prognostic factors in esophageal cancer regardless of neoadjuvant chemoradiation or lymphadenectomy extent.
ABSTRACT To investigate whether the number of lymph nodes metastasis (LNMs) and the ratio between metastatic and examined lymph nodes (LNs) are better prognostic factors when compared with traditional staging systems in patients with esophageal carcinoma.
The accuracy of the 6th UICC/TNM classification is suboptimal, especially when not taking into account neoadjuvant therapy and lymphadenectomy extent.
For 536 patients who underwent curative en bloc esophagectomy, in whom 51.5% (n = 276) received neoadjuvant chemoradiation, LNMs were classified according to the 6th UICC/TNM classification and systems based on the number (< or =4 and >4) or the ratio (< or =0.2 and >0.2) of LNMs. Survival of the respective stages, predictors of survival, and influence of both chemoradiation and number of examined LNs were studied.
After a median follow-up of 50 months, the 5-year survival rates were 47% for the entire population, significantly poorer for patients with >4 LNMs (8% vs. 53%, P < 0.001) or a ratio of LNMs >0.2 (22% vs. 54%, P < 0.001). After adjustment for confounding variables, a number of LNMs >4 and a ratio of LNMs >0.2 were the only predictors of poor prognosis. The prognostic role of both the number and the ratio of LNMs was maintained whether patients received neoadjuvant chemoradiation or not. Moreover, LN ratio is shown to be more accurate for inadequately staged patients (<15 examined LNs), whereas the number of LNMs is pertinent for adequately staged patients (> or =15 examined LNs).
Staging systems for esophageal cancer that use the number (< or =4 or >4) and the ratio (< or =0.2 or >0.2) of LNMs have greater prognostic importance than the current staging systems because of the good stratification of the groups and their clinical utility, taking into account neoadjuvant therapy and lymphadenectomy extent.
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ABSTRACT: Self-expanding metallic stents (SEMSs) have been used as a bridge to surgery, relieving dysphagia and maintaining nutrition, in patients with operable but obstructive esophageal cancer (EC). However, the impact of SEMSs on oncologic outcomes is unknown. The aim of this study was to evaluate the impact of SEMS insertion before EC surgery on oncologic outcomes. From 2000 to 2010, two thousand nine hundred and forty-four patients who underwent an operation for EC with a curative intent were included in a multicenter European cohort. Through propensity score analysis, patients who underwent SEMS insertion (SEMS group, n = 38) were matched 1:4 to control patients who did not undergo SEMS insertion (control group, n = 152). The SEMS and control groups were comparable according to age, sex, tumor location, clinical stage, American Society of Anesthesiologists score, dysphagia, malnutrition, neoadjuvant treatment administration, histology, and surgical procedure. Self-expanding metallic stent insertion was complicated by tumoral perforation in 2 patients. The in-hospital postoperative mortality and morbidity rates for the SEMS vs control groups were 13.2% vs 8.6% (p = 0.370) and 63.2% vs 59.2% (p = 0.658), respectively. The R0 resection rate (71.0% vs 85.5%; p = 0.041), median time to recurrence (6.5 vs 9.0 months; p = 0.040), and 3-year overall survival (25% vs 44%; p = 0.023) were significantly reduced in the SEMS group, and the 3-year locoregional recurrence rate was increased (62% vs 34%; p = 0.049). The results remained significant after excluding SEMS-related esophageal perforations. After adjusting for confounding factors, SEMS insertion was a predictor of poor prognosis (hazard ratio = 1.6; p = 0.038). Self-expanding metallic stent insertion, as a bridge to surgery, has a negative impact on oncologic outcomes in EC. Clinicaltrials.gov ID: NCT 01927016. Copyright © 2015 American College of Surgeons. Published by Elsevier Inc. All rights reserved.Journal of the American College of Surgeons 12/2014; 220(3). DOI:10.1016/j.jamcollsurg.2014.11.028 · 4.45 Impact Factor
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ABSTRACT: Background Supraclavicular node metastasis is common in patients with esophageal cancer. However, considerable controversy remains regarding whether the supraclavicular node metastasis means regional node or distant metastasis. This research investigated the frequency of supraclavicular node metastasis in patients with esophageal squamous cell carcinoma (ESCC), identified the factors correlated with supraclavicular node metastasis, and evaluated the clinical relevance of supraclavicular node metastasis in thoracic ESCC. Methods We retrospectively analyzed the clinical data of 276 consecutive patients with thoracic ESCC who underwent esophagectomy with three-field lymph node dissection in the First Affiliated Hospital of Zhengzhou University from January 2000 to December 2008. Results The frequency of supraclavicular node metastasis was 26.1 %. Correlation analysis showed that higher tumor location, longer tumor length, higher pathologic T stage, and lower histologic grade were associated with a higher frequency of supraclavicular node metastasis (all p < 0.05). Patients with solitary supraclavicular node metastasis had a significantly lower 5-year cumulative survival rate than those with solitary cervical paraesophageal node metastasis (26.9 vs 50.3 %, p < 0.05). Conclusions Higher tumor location, longer tumor length, higher pathologic T stage, and lower histologic grade are associated with a higher frequency of supraclavicular node metastasis. Supraclavicular node metastasis indicates a worse prognosis for patients with thoracic ESCC compared with cervical paraesophageal node metastasis, and it should be classified as M1.European Surgery 08/2014; 46(4):139-143. DOI:10.1007/s10353-014-0272-x · 0.26 Impact Factor
Esophagus 09/2014; 11(4):258-266. DOI:10.1007/s10388-014-0440-x · 0.74 Impact Factor