Outcome of histologically node‐negative esophageal squamous cell carcinoma

• Published in: World journal of surgery 2002-12, Vol.26 (12), p.1446-1451
• Main Authors: Tabira, Yoichi, Yasunaga, Masahiro, Sakaguchi, Tomonori, Yamaguchi, Yuji, Okuma, Toshiyuki, Kawasuji, Michio
• Format: Article
• Language: English
• Subjects: Adult; Age Distribution; Aged; Biological and medical sciences; Biopsy, Needle; Carcinoma, Squamous Cell - mortality; Carcinoma, Squamous Cell - pathology; Carcinoma, Squamous Cell - therapy; Chemosensitivity Testing; Cohort Studies; Combined Modality Therapy - methods; Esophageal Cancer; Esophageal Carcinoma; Esophageal Neoplasms - mortality; Esophageal Neoplasms - pathology; Esophageal Neoplasms - therapy; Esophageal Squamous Cell Carcinoma; Esophagus; Female; Gastroenterology. Liver. Pancreas. Abdomen; Humans; Incidence; Lymph Nodes - pathology; Male; Medical sciences; Middle Aged; Neoplasm Invasiveness - pathology; Neoplasm Recurrence, Local - mortality; Neoplasm Recurrence, Local - pathology; Neoplasm Recurrence, Local - therapy; Neoplasm Staging; Preoperative Chemotherapy; Probability; Prognosis; Retrospective Studies; Risk Assessment; Sex Distribution; Statistics, Nonparametric; Survival Rate; Treatment Outcome; Tumors
• ISSN: 0364-2313; 1432-2323
• DOI: 10.1007/s00268-002-6415-4

The outcome of node‐negative esophageal carcinoma and the prognostic significance of lymph node micrometastasis remain unknown. The aim of this retrospective study was to clarify these two points. A series of 98 patients who underwent curative operation for histologically node‐negative (pNO in TNM classification) esophageal carcinoma were enrolled in the study. We reviewed the cause of death of these patients. The survival curves were calculated and compared after stratifications according to clinicopathologic parameters. Lymph node micrometastasis in the patients with recurrences was examined using immunohistochemical staining of cytokeratin. Their ages ranged from 45 to 83 years (mean 64.3 years). There were 83 men and 15 women. Altogether, 54 patients were still alive, and 44 had died. A total of 9 patients died from recurrence of their esophageal carcinoma, 33 died from other causes (pneumonia 11, extraesophageal carcinoma 7, and so on), and 2 died from unknown causes. Eight patients had locoregionai recurrences, and two patients had distant recurrences. The overall survival rate for the 98 patients was 58.2%. The survival for patients with pT2 or pT3 tumors was significantly worse than for those with pTis or pTl tumors (p=0.02, log‐rank test). Other clinicopathologic factors did not affect the prognosis. Immunohistochemical study found no lymph node micrometastasis in 365 lymph nodes resected from the patients with recurrences. Only the depth of tumor invasion affected the outcome of patients with node‐negative esophageal carcinoma. Altogether, 75% of patients died of other causes without recurrence, with the two main causes of death being pulmonary complications and extraesophageal carcinoma in these patients. Lymph node micrometastasis was not associated with recurrence in this series. Résumé L’évolution des cancers de lœsophage NO et la signification des micrométastases ganglionnaires resent inconnues. Le but de cette étude rétrospective a été de clarifier ces deux problèmes. Nous avons inclus dans cette étude, 98 patients qui ont eu une résection à visée curative pour un cncer de l’œsophage (pNO selon la classificaton TNM). Nous avons revu les causes de mortalité chez ces patients. Les courbes de survie ont été calculées et comparées après stratification selon les données clinicopathologiques. Les micrométastases ganglionnaires chez les patients récidives ont été déterminées par une coloration immunohistochimique de la cytokératine. L’àge des pati