Significance of immunohistochemical nodal micrometastasis as a prognostic indicator in potentially curable oesophageal carcinoma

Abstract

Background: The number of positive lymph nodes is an important prognostic predictor in patients with oesophageal cancer. However, the signi®cance of nodal micrometastasis in patients with overt nodal metastasis is unknown. The aim of this study was to clarify the clinical implications of nodal micrometastasis in patients undergoing curative oesophagectomy for oesophageal cancer.Methods: Cervical, mediastinal and abdominal lymph nodes systematically removed from 104 patients with oesophageal cancer were examined immunohistochemically to detect cells that stained positively for cytokeratins with the monoclonal antibody cocktail AE1/AE3. The postoperative course and survival rates were compared among patients with and without micrometastases, after numerical classi®cation of overt metastatic nodes (none, between one and four, ®ve or more).Results: Univariate analysis showed T stage, nodal micrometastasis and number of overt nodal metastases to be signi®cant prognostic factors after oesophagectomy. Multivariate analysis revealed nodal micrometastasis and number of overt nodal metastases to be independent prognostic factors. The presence of micrometastases had a signi®cant adverse effect on postoperative survival in patients with no overt metastasis and in patients with one to four overt metastatic nodes, but no such impact in patients with ®ve or more overt metastatic nodes.Conclusion: Assessment of nodal status by both histological examination for overt metastases and immunohistochemical examination for micrometastases is useful in stratifying patients undergoing curative oesophagectomy.

Lymph node metastases and prognosis in oesophageal carcinoma – A systematic review

“…There is a strong body of evidence suggesting that immunohistochemically detected micrometastatic deposits in oesophageal cancer are associated with reduced survival and increased risk of disease recurrence [55][56][57][58][59][60][61][62][63][64][65]. Several studies have identified micrometastatic spread to be an independent prognostic indicator in oesophageal adenocarcinoma [35,39,41,43,66] and it has been postulated that these micrometastatic deposits may help to explain why up to 50% of histologically nodenegative oesophageal cancer patients develop recurrence, despite a curative resection of the primary tumour [67,68].…”

Prognostic Significance of Simultaneous Presence of Histological and Immunohistochemical Metastasis to Lymph Nodes in Patients with Esophageal Cancer

“…Of the limited research conducted to date, Komukai, et al found that the predictive power of iNM in node-positive esophageal cancer patients varies according to the number of positive nodes, being a significant indicator of poor survival in patients with four or fewer positive nodes but not in patients with five or more. 3) Thus, the identification of a new predictor of overall survival for all patients with esophageal cancer undergoing R0 resection, regardless of whether they undergo preoperative treatment-the simultaneous presence of pNM and iNM-in the present study is significant. Specifically, simultaneous presence of pNM and iNM was found to be the only independent prognostic factor in patients who had undergone preoperative treatment, and not a factor in patients who had not undergone preoperative treatment.…”

“…3,4) Although several studies have reported that the predictive value of iNM differs among patients according to the number of pathological lymph node metastases, 3) the significance of simultaneous pNM and iNM has not been reported to date.…”

Sentinel Node Navigation Surgery in Early-Stage Esophageal Cancer

“…[27][28][29][30] On the other hand, many reports have indicated that immunohistochemical nodal micrometastasis is a significant prognostic indicator in patients with cN0 esophageal cancer. [31][32][33] Although SN mapping in esophageal cancer is obviously more invasive than other imaging techniques, nodal micrometastasis in SN that may affect survival of the patient cannot be ignored. At present, SN biopsy is believed to detect micrometastasis more accurately and cost-effectively than other imaging procedures in patients with cN0 early esophageal cancer.…”