Lymph Node and Bone Marrow Micrometastases Define the Prognosis of Patients with pN0 Esophageal Cancer

Abstract

Background: Pathological routine lymph node staging is postulated to be the main oncological prognosticator in esophageal cancer (EC). However, micrometastases in lymph nodes (LNMM) and bone marrow (BNMM) are discussed as the key events in tumor recurrence. We assessed the prognostic significance of the LNMM/BNMM status in initially pN0 staged patients with curative esophagectomy. Methods: From 110 patients bone marrow aspirates and lymph node tissues were analyzed. For LNMM detection immunohistochemistry was performed using the anticytokeratin antibody AE1/AE3. To detect micrometastases in the bone marrow a staining with the pan-keratin antibody A45-B/B3 was done. Results were correlated with clinicopathologic parameters as well as recurrence and death during follow-up time. Results: Thirty-eight (34.5%) patients showed LNMM, whereas in 54 (49.1%) patients BNMM could be detected. LNMM and BNMM positive patients showed a correlation to an increased pT category (p = 0.017). Univariate and multivariate analyses revealed that the LNMM/BNMM status and especially LNMM skipping the anatomical lymph node chain were significant independent predictors of overall survival and recurrence-free survival. Conclusions: This study indicates that routine pathological staging of EC is insufficient. Micrometastases in lymph nodes and the bone marrow seem to be the main reason for tumor recurrence and they are a strong prognosticator following curative treatment of pN0 EC.

Pathological complete response after neoadjuvant treatment determines survival in esophageal squamous cell carcinoma patients (NEOCRTEC5010)

“…The study indicated that a high lymph node yield was associated with improved overall survival. A possible explanation for the extension of overall survival could be the removal of micrometastases (13,14).…”

Controversies in EUS: Do we need miniprobes?

“…Considering the ever-growing sophistication and sensitivity of other imaging techniques,[ 58 59 ] and, on the other hand, the week correlation of LN-size or shape with malignancy[ 60 61 ] and therefore unsatisfactory sensitivity of conventional EUS for malignant lymph nodes,[ 62 ] the role of EUS in defining the N category seems more than questionable. If malignant LN of 3 mm median size,[ 63 ] lymph node and bone marrow micrometastases,[ 61 ] vascular and lymphatic invasion, and tumor budding[ 55 ] define the prognosis of patients with pR0 SEC, sonomorphology of advanced tumors and lymph nodes becomes irrelevant. However, local pathological anatomy matters.…”