Advertisement

Annals of Surgical Oncology

, Volume 17, Issue 3, pp 784–790 | Cite as

How Does the Number of Resected Lymph Nodes Influence TNM Staging and Prognosis for Esophageal Carcinoma?

  • Yang Hu
  • Chunyan Hu
  • Helin Zhang
  • Yumin Ping
  • Long-Qi Chen
Thoracic Oncology

Abstract

Background

It is proposed by International Union Against Cancer (UICC) and American Joint Committee on Cancer (AJCC) that at least 6 lymph nodes (LN) should be removed during resection of esophageal cancer for an accurate N classification. However, large series evidence is needed. The aim of this study is to assess the impact of total number of removed LNs during esophagectomy on UICC-TNM staging and long-term survival.

Materials and Methods

The clinicopathological data and follow-up results of 1098 patients with advanced esophageal carcinoma who underwent an esophagectomy were analyzed.

Results

The survival experience of group A (removed LNs <6) was worse than that of group B (removed LNs ≥6). With the stratification analysis according to N and TNM stage, for patients with pN0 cancers, the survival in group A was worse than that in group B (P = .003), while in patients with 1 and ≥2 positive LNs, the survival experience was similar (P = .919 and .182, respectively). A significant difference in survival in patients at stage IIa was observed between group A and group B (P = .005). However, the survival in patients at stage IIb and stage III was not different between the two groups (P = .302 and 0.108, respectively).

Conclusions

For advanced esophageal carcinoma, if the number of resected LNs per operation is less than 6, an occult positive regional LN might be missed, resulting in an inaccurate N classification. The minimum of 6 LNs removed for esophageal cancer recommended by UICC and AJCC is rational and should be complied with.

Keywords

Esophageal Cancer Esophageal Squamous Cell Carcinoma Esophageal Carcinoma Survival Experience Positive Margin Rate 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

References

  1. 1.
    Parkin DM, Bray F, Ferlay J, Pisani P. Global cancer statistics, 2002. CA Cancer J Clin. 2005;55:74–108.CrossRefPubMedGoogle Scholar
  2. 2.
    Li JY. Epidemiology of esophageal cancer in China. Natl Cancer Inst Monogr. 1982;62:113–20.PubMedGoogle Scholar
  3. 3.
    Devesa SS, Blot WJ, Fraumeni JF, Jr. Changing patterns in the incidence of esophageal and gastric carcinoma in the United States. Cancer. 1998;83:2049–53.CrossRefPubMedGoogle Scholar
  4. 4.
    Mayer RJ. Overview: The changing nature of esophageal cancer. Chest. 1993;103:404S–5S.CrossRefPubMedGoogle Scholar
  5. 5.
    Gockel I, Sultanov FS, Domeyer M, Trinh TT, Gonner U, Junginger T. Surgical therapy for esophageal carcinoma: A prospective 20-year analysis. Zentralbl Chir. 2008;133:260–6.CrossRefPubMedGoogle Scholar
  6. 6.
    Gastinger I. Esophageal carcinoma: Results after esophageal resection. Chirurg. 2008;79:61–5.CrossRefPubMedGoogle Scholar
  7. 7.
    Shimada H, Okazumi S, Matsubara H, Shiratori T, Shuto K, Akutsu Y, et al. Surgical outcome after the clearance of abdominal metastatic lymph nodes in 138 patients with thoracic esophageal carcinoma. Am J Surg. 2007;193:448–52; discussion 453.CrossRefPubMedGoogle Scholar
  8. 8.
    Zhang H, Ping Y, Du X. Study on factors influencing survival in patients with cancer of the esophagus after resection by Cox proportional hazard model. Zhonghua Zhong Liu Za Zhi. 1999;21:32–4.PubMedGoogle Scholar
  9. 9.
    Christein JD, Hollinger EF, Millikan KW. Prognostic factors associated with resectable carcinoma of the esophagus. Am Surg. 2002;68:258–62.PubMedGoogle Scholar
  10. 10.
    Greene FL, Page DL, Fleming ID, Fritz A, Balch CM, Haller DG et al., editors. American joint committee on cancer: AJCC cancer staging manual. 6th ed. New York: Springer, 2002.Google Scholar
  11. 11.
    Sorbin LH, Wittkind CL. 2002. TNM classification of malignant tumors. 6th ed. New York: Wiley & Sons.Google Scholar
  12. 12.
    Sun KL, Zhang RG, Zhang D, Huang G, Wang L. Prognostic significance of lymph node metastasis in surgical resection of esophageal cancer. Chin Med J (Engl). 1996;109:89–92.Google Scholar
  13. 13.
    Natsugoe S, Matsumoto M, Okumura H, Ikeda M, Ishigami S, Owaki T, et al. Prognostic factors in patients with submucosal esophageal cancer. J Gastrointest Surg. 2004;8:631–5.CrossRefPubMedGoogle Scholar
  14. 14.
    Tachibana M, Yoshimura H, Kinugasa S, Dhar DK, Shibakita M, Ohno S, et al. Clinicopathologic factors correlated with number of metastatic lymph nodes in oesophageal cancer. Dig Liver Dis. 2001;33:534–8.CrossRefPubMedGoogle Scholar
  15. 15.
    Bollschweiler E, Baldus SE, Schroder W, Schneider PM, Hölscher AH. Staging of esophageal carcinoma: Length of tumor and number of involved regional lymph nodes. Are these independent prognostic factors? J Surg Oncol. 2006;94:355–63.CrossRefPubMedGoogle Scholar
  16. 16.
    Eloubeidi MA, Desmond R, Arguedas MR, Reed CE, Wilcox CM. Prognostic factors for the survival of patients with esophageal carcinoma in the U.S.: The importance of tumor length and lymph node status. Cancer. 2002;95:1434–43.CrossRefPubMedGoogle Scholar
  17. 17.
    Kunisaki C, Akiyama H, Nomura M, Matsuda G, Otsuka Y, Ono HA, et al. Developing an appropriate staging system for esophageal carcinoma. J Am Coll Surg. 2005;201:884–90.CrossRefPubMedGoogle Scholar
  18. 18.
    Mariette C, Piessen G, Briez N, Triboulet JP. 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. Ann Surg. 2008;247:365–71.CrossRefPubMedGoogle Scholar
  19. 19.
    Wang Y, Wang L, Zhang D. Characteristics of lymph node metastasis of squamous cell carcinoma of thoracic esophagus and its clinical significance. Zhonghua Zhong Liu Za Zhi. 2000;22:241–3.PubMedGoogle Scholar
  20. 20.
    Tachibana M, Kinugasa S, Dhar DK, Kotoh T, Shibakita M, Ohno S, et al. Prognostic factors after extended esophagectomy for squamous cell carcinoma of the thoracic esophagus. J Surg Oncol. 1999;72:88–93.CrossRefPubMedGoogle Scholar
  21. 21.
    Kimura H, Konishi K, Arakawa H, Oonishi I, Kaji M, Maeda K, et al. Number of lymph node metastases influences survival in patients with thoracic esophageal carcinoma: Therapeutic value of radiation treatment for recurrence. Dis Esophagus. 1999;12:205–8.CrossRefPubMedGoogle Scholar
  22. 22.
    Rice TW, Blackstone EH, Rybicki LA, Adelstein DJ, Murthy SC, DeCamp MM, et al. Refining esophageal cancer staging. J Thorac Cardiovasc Surg. 2003;125:1103–13.CrossRefPubMedGoogle Scholar
  23. 23.
    Kawahara K, Maekawa T, Okabayashi K, Shiraishi T, Yoshinaga Y, Yoneda S, et al. The number of lymph node metastases influences survival in esophageal cancer. J Surg Oncol. 1998;67:160–3.CrossRefPubMedGoogle Scholar
  24. 24.
    Rizk N, Venkatraman E, Park B, Flores R, Bains MS, Rusch V. The prognostic importance of the number of involved lymph nodes in esophageal cancer: Implications for revisions of the American Joint Committee on Cancer staging system. J Thorac Cardiovasc Surg. 2006;132:1374–81.CrossRefPubMedGoogle Scholar
  25. 25.
    Wilson M, Rosato EL, Chojnacki KA, Chervoneva I, Kairys JC, Cohn HE, et al. Prognostic significance of lymph node metastases and ratio in esophageal cancer. J Surg Res. 2008;146:11–5.CrossRefPubMedGoogle Scholar
  26. 26.
    Shimada H, Okazumi S, Matsubara H, Nabeya Y, Shiratori T, Shimizu T, et al. Impact of the number and extent of positive lymph nodes in 200 patients with thoracic esophageal squamous cell carcinoma after three-field lymph node dissection. World J Surg. 2006;30:1441–9.CrossRefPubMedGoogle Scholar
  27. 27.
    Xiao ZF, Yang ZY, Miao YJ, Wang LH, Yin WB, Gu XZ, et al. Influence of number of metastatic lymph nodes on survival of curative resected thoracic esophageal cancer patients and value of radiotherapy: Report of 549 cases. Int J Radiat Oncol Biol Phys. 2005;62:82–90.CrossRefPubMedGoogle Scholar
  28. 28.
    Fujita H, Sueyoshi S, Tanaka T, Fujii T, Toh U, Mine T, et al. Optimal lymphadenectomy for squamous cell carcinoma in the thoracic esophagus: Comparing the short- and long-term outcome among the four types of lymphadenectomy. World J Surg. 2003;27:571–9.CrossRefPubMedGoogle Scholar
  29. 29.
    Law S, Wong J. Two-field dissection is enough for esophageal cancer. Dis Esophagus. 2001;14:98–103.CrossRefPubMedGoogle Scholar
  30. 30.
    Law S, Wong J. The roles of multimodality treatment and lymphadenectomy in the management of esophageal cancer. Chin Med J (Engl). 1997;110:819–25.Google Scholar
  31. 31.
    Lu ZM, Zhang H, Wang MH, Cui DH, Yang YQ, Huang HZ. Lymphatic metastasis intensity of and lymphadenectomy for thoracic esophageal squamous cell carcinoma. Ai Zheng. 2006;25:604–8.PubMedGoogle Scholar
  32. 32.
    Li H, Zhang Y, Cai H, Xiang J. Pattern of lymph node metastases in patients with squamous cell carcinoma of the thoracic esophagus who underwent three-field lymphadenectomy. Eur Surg Res. 2007;39:1–6.CrossRefPubMedGoogle Scholar
  33. 33.
    Takemura M, Osugi H, Takada N, Kinoshita H, Higashino M. Prognostic factors in patients with squamous oesophageal cancer associated with solitary lymph node metastasis after oesophagectomy and extended lymphadenectomy. Oncol Rep. 2003;10:75–80.PubMedGoogle Scholar
  34. 34.
    Bogoevski D, Onken F, Koenig A, Kaifi JT, Schurr P, Sauter G, et al. Is it time for a new TNM classification in esophageal carcinoma? Ann Surg. 2008;247:633–41.CrossRefPubMedGoogle Scholar
  35. 35.
    Greenstein AJ, Litle VR, Swanson SJ, Divino CM, Packer S, Wisnivesky JP. Effect of the number of lymph nodes sampled on postoperative survival of lymph node-negative esophageal cancer. Cancer. 2008;112:1239–46.CrossRefPubMedGoogle Scholar
  36. 36.
    Dutkowski P, Hommel G, Bottger T, Schlick T, Junginger T. How many lymph nodes are needed for an accurate pN classification in esophageal cancer? Evidence for a new threshold value. Hepatogastroenterology. 2002;49:176–80.PubMedGoogle Scholar
  37. 37.
    Altorki NK, Zhou XK, Stiles B, Port JL, Paul S, Lee PC, et al. Total number of resected lymph nodes predicts survival in esophageal cancer. Ann Surg. 2008;248:221–6.CrossRefPubMedGoogle Scholar
  38. 38.
    Fraunberger L, Kraus B, Dworak O. Distribution of lymph nodes and lymph node metastases in esophageal carcinoma. Zentralbl Chir. 1996;121:102–5.PubMedGoogle Scholar

Copyright information

© Society of Surgical Oncology 2009

Authors and Affiliations

  • Yang Hu
    • 1
  • Chunyan Hu
    • 2
  • Helin Zhang
    • 3
  • Yumin Ping
    • 4
  • Long-Qi Chen
    • 1
  1. 1.Department of Thoracic SurgeryWest China Hospital, Sichuan UniversityChengduChina
  2. 2.Department of PathologyNational Chengdu Center for Safety Evaluation of DrugsChengduChina
  3. 3.Department of Thoracic SurgerySecond Hospital, Hebei Medical UniversityShijiazhuangChina
  4. 4.Department of Thoracic SurgeryFourth Hospital, Hebei Medical UniversityShijiazhuangChina

Personalised recommendations