Prognostic significance of lymph node metastases and ratio in esophageal cancer.

Authors

• Matthew Wilson
• Ernest L Rosato
• Karen A Chojnacki
• Inna Chervoneva
• John C Kairys
• Herbert E Cohn
• Francis E Rosato
• Adam C Berger

Publication/Presentation Date

5-1-2008

Abstract

BACKGROUND: The incidence of carcinoma of the distal esophagus and GE junction is rapidly increasing. A large single-center experience was reviewed to determine the impact of lymph node positivity and ratio on survival.

METHODS: All patients undergoing esophagogastrectomy at Thomas Jefferson University Hospital between January 1994 and December 2004 were reviewed. Univariate and multivariate analyses were performed using log-rank and Cox proportional hazard models, and survival curves were estimated using the Kaplan-Meier method.

RESULTS: Of 173 patients with invasive cancer, 123 (71%) underwent preoperative chemoradiation therapy. The largest number of patients (45%) had adenocarcinoma of the GE junction; 29% of patients had esophageal adenocarcinoma while 14% had squamous cell cancer of the esophagus. Perioperative mortality was 5.7%. Median overall survival of the entire group was 22 months and 5-year overall survival was 27%. The most significant prognostic factor for overall survival was the presence of positive LN (P = 0.01). Additionally, patients with zero involved LN had a 5-year survival of 34%, while patients with 1 to 3 positive LN and >3 positive LN had 5-year survival of 27% and 9%, respectively (P = 0.01). Finally, an increasing ratio of positive to examined LN was linearly associated with a worsening 5-year survival, (P = 0.153).

CONCLUSIONS: Increasing number of positive LN in patients with esophageal cancer and increasing ratio of metastatic to examined LN portend a poor prognosis. These factors should play an important role in determining which patients receive adjuvant therapy.

Volume

146

Issue

1

First Page

11

Last Page

15

ISSN

0022-4804

Published In/Presented At

Wilson, M., Rosato, E. L., Chojnacki, K. A., Chervoneva, I., Kairys, J. C., Cohn, H. E., Rosato, F. E., Sr, & Berger, A. C. (2008). Prognostic significance of lymph node metastases and ratio in esophageal cancer. The Journal of surgical research, 146(1), 11–15. https://doi.org/10.1016/j.jss.2007.07.028

Disciplines

Business Administration, Management, and Operations | Health and Medical Administration | Management Sciences and Quantitative Methods

PubMedID

18028955

Department(s)

Administration and Leadership

Document Type

Article