Node status in transmural esophageal adenocarcinoma and outcome after en bloc esophagectomy

Nigro, John J.; DeMeester, Steven R.; Hagen, Jeffrey A.; DeMeester, Tom R.; Peters, Jeffrey H.; Kiyabu, Milton; Campos, Guilherme M.; Öberg, Stefan; Gastal, Otávio Leite; Crookes, Peter F.; Bremner, Cedric G.

doi:10.1016/s0022-5223(99)70377-6

Cited by 137 publications

(88 citation statements)

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“…In addition, the presence and the number of lymph node metastases in these patients was the most significant predictor of survival. 6 Those investigators found that the 5-year survival rate was 23% in patients with Յ 4 involved lymph nodes, but the rate decreased to 12% for patients with Ͼ 4 lymph node metastases. Correspondingly, the likelihood of developing recurrent disease increased from 53% to 90%, respectively.…”

Section: Discussionmentioning

confidence: 97%

“…We also showed that, the higher the number of lymph nodes involved, as well as the ratio of positive lymph nodes, the poorer the survival of patients with esophageal carcinoma. One study 6 found that the number of involved lymph nodes, irrespective of the depth of tumor invasion, was correlated with the subsequent development of systemic metastasis: 0% for patients with no involved lymph nodes, 45% for patients with 1-4 involved lymph nodes, 80% for patients with 5-9 involved lymph nodes, and 92% for patients with Ͼ 10 involved lymph nodes. In addition, the presence and the number of lymph node metastases in these patients was the most significant predictor of survival.…”

Section: Discussionmentioning

confidence: 99%

“…Correspondingly, the likelihood of developing recurrent disease increased from 53% to 90%, respectively. 6 Patients with Ͼ 10 involved lymph nodes had a particularly poor prognosis, and all developed recurrent disease or died of their disease. Patients with a ratio of the number of lymph nodes removed to the number involved after en bloc resection of Ͻ 0.1 had a significantly better survival rate.…”

Section: Discussionmentioning

confidence: 99%

“…Patients with a ratio of the number of lymph nodes removed to the number involved after en bloc resection of Ͻ 0.1 had a significantly better survival rate. 6 Korst and colleagues 5 evaluated the influence of the number and location of involved lymph nodes on survival in 195 patients with esophageal carcinoma. In their study, 5 patients with no lymph node involvement had the best survival compared with other groups.…”

Section: Discussionmentioning

confidence: 99%

“…4 Few studies with small numbers of patients from the western literature focused on staging issues in patients with esophageal carcinoma, in particular, the location of lymph nodes and the number of lymph nodes involved. [5][6][7] With the continued rise in adenocarcinoma of the distal esophagus, 8,9 these issues become even more important. The current TNM (1997 AJCC) classification system 10 does not consider the tumor length or the number of lymph nodes in the staging and classification scheme for patients with esophageal carcinoma.…”

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Prognostic factors for the survival of patients with esophageal carcinoma in the U.S.

Eloubeidi

Desmond

Arguedas

et al. 2002

Cancer

364

224

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BACKGROUNDThe current TNM classification system does not consider tumor length or the number of lymph nodes in the staging and classification scheme for patients with esophageal carcinoma. Using data from the National Cancer Institute SEER Program, the authors explored the effect of tumor length and number of positive lymph nodes on survival in patients with esophageal carcinoma.METHODSPatients with esophageal adenocarcinoma or squamous cell carcinoma were subgrouped according to historic stage with localized, regional, or distant disease. Demographic factors (age at diagnosis, race, and gender) and tumor characteristics (morphology, histologic grade, tumor length, primary site, depth of invasion, number of positive lymph nodes, proportion of positive lymph nodes dissected, and distant metastatic sites) were examined.RESULTSOverall factors that were associated with an increased mortality risk included increasing age at diagnosis, black race versus white race, histologic grade, primary tumor site in the lower esophagus and abdomen versus upper regions, and increasing depth of invasion. Among patients with regional disease, the number of positive lymph nodes (≥ 5 vs. < 5) was related to an increasing risk (hazard ratio [HR], 1.29; 95% confidence interval [95%CI], 1.06–1.56). The proportion of positive lymph nodes compared with the number of lymph nodes dissected conferred an increased risk (HR, 1.63; 95%CI, 1.26–2.11). Among patients with distant disease, sites other than distant lymph nodes implied an increased mortality risk (HR, 1.37; 95%CI, 1.37–1.65). Tumor length was an independent predictor of mortality when controlling for depth of invasion in patients with localized disease (HR, 1.15; 95%CI, 1.08–1.21).CONCLUSIONSTumor length, the number of involved lymph nodes, and the ratio of positive lymph nodes are important prognostic factors for survival in patients with esophageal carcinoma. A revised TNM classification system for patients with esophageal carcinoma might consider adding tumor length and number of positive lymph nodes as two important prognostic factors. Cancer 2002;95:1434–43. © 2002 American Cancer Society.DOI 10.1002/cncr.10868

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Section: Discussionmentioning

confidence: 97%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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confidence: 99%

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