Premium
Effect of the number of lymph nodes sampled on postoperative survival of lymph node‐negative esophageal cancer
Author(s) -
Greenstein Alexander J.,
Litle Virginia R.,
Swanson Scott J.,
Divino Celia M.,
Packer Stuart,
Wisnivesky Juan P.
Publication year - 2008
Publication title -
cancer
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.052
H-Index - 304
eISSN - 1097-0142
pISSN - 0008-543X
DOI - 10.1002/cncr.23309
Subject(s) - medicine , esophageal cancer , lymph node , cancer , surveillance, epidemiology, and end results , lymph , oncology , confounding , esophagectomy , stage (stratigraphy) , proportional hazards model , cancer staging , cancer registry , surgery , pathology , paleontology , biology
BACKGROUND The presence of lymph node (LN) metastases in esophageal cancer has important prognostic and treatment implications. However, the optimal number of LNs that should be examined for accurate staging is controversial. In the current study, the association between survival and the number of LNs evaluated was examined in patients who underwent resection of lymph node‐negative (American Joint Committee on Cancer [AJCC] TNM stage I‐IIA) esophageal cancer. METHODS All patients were identified who underwent surgery for lymph node‐negative esophageal cancer between 1988 and 2003 from the Surveillance, Epidemiology, and End Results cancer registry. Patients were classified into 3 groups by the number of negative LNs sampled during surgery (≤10 LNs, 11‐17 LNs, and ≥18 LNs). Esophageal cancer‐specific survival was compared among these LN groups using Kaplan‐Meier curves. Stratified and Cox regression analyses were used to evaluate the association between survival and the number of negative LNs after adjusting for potential confounders. RESULTS A total of 972 patients were included in the study. Disease‐specific survival rates increased with a higher number of negative LNs. The 5‐year disease‐specific survival rate was 55% among patients with ≤10 negative LNs, compared with 66% and 75%, respectively, for those with 11 to 17 negative LNs and ≥18 negative LNs. The number of negative LNs was found to be significantly associated with survival in analyses stratified by tumor status. On multivariate regression controlling for age, race/ethnicity, sex, histology, tumor status, and postoperative radiotherapy, a higher number of negative LNs was found to be independently associated with higher disease‐specific survival. CONCLUSIONS The presence of LN metastases in patients with esophageal cancer appears to have important prognostic and treatment implications. Data from the current study suggest that patients undergoing surgical resection for esophageal cancer should have at least 18 LNs removed. Cancer 2008. © 2008 American Cancer Society.