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. 2008 May 1;146(1):11-5.
doi: 10.1016/j.jss.2007.07.028. Epub 2007 Aug 28.

Prognostic significance of lymph node metastases and ratio in esophageal cancer

Matthew Wilson  1 , Ernest L Rosato, Karen A Chojnacki, Inna Chervoneva, John C Kairys, Herbert E Cohn, Francis E Rosato Sr, Adam C Berger
Affiliations

Prognostic significance of lymph node metastases and ratio in esophageal cancer

Matthew Wilson et al. J Surg Res. .

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.

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Figures

Figure 1
Figure 1
Kaplan-Meier curve demonstrating overall survival for patients by lymph node category.
Figure 2
Figure 2
Kaplan-Meier curve demonstrating overall survival for patients by lymph node ratio category.
See this image and copyright information in PMC

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