HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Nabil Rizk Bernard Park Raja Flores Manjit S. Bains Valerie Rusch Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Rizk, N. Articles by Rusch, V. Search for Related Content PubMed PubMed Citation Articles by Rizk, N. Articles by Rusch, V.

J Thorac Cardiovasc Surg 2006;132:1374-1381
© 2006 The American Association for Thoracic Surgery

General Thoracic Surgery

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

^a Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
^b The Biostatistics Service, Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY.

Received for publication December 19, 2005; revisions received March 28, 2006; accepted for publication July 12, 2006.

^_* Address for reprints: Nabil Rizk, MD, Memorial Sloan-Kettering Cancer Center, 1275 York Ave, New York, NY 10021 (Email: rizkn{at}mskcc.org).

OBJECTIVE: The American Joint Committee on Cancer (AJCC) staging system for esophageal cancer is controversial because it relies on arbitrary definitions of the anatomic location of lymph nodes to establish N and M status. It has been proposed that the number of involved lymph nodes may better predict survival. We reviewed our experience to determine the prognostic impact of the number of involved nodes and the extent of lymphadenectomy on the current staging system.

METHODS: Records of all patients who underwent resection of previously untreated adenocarcinoma and squamous cell carcinoma of the esophagus and gastroesophageal junction were reviewed. Overall survival according to the AJCC staging system and the number of involved lymph nodes was analyzed by the method of Kaplan and Meier and by recursive partitioning methods.

RESULTS: Data were available on 336 patients operated on between January 1996 and September 2003. Recursive partitioning analysis using AJCC staging variables reproduced the AJCC staging system. When the number of involved lymph nodes is added, patients with more than 4 involved lymph nodes have survival similar to that of patients with M1 disease, and patients with no involved lymph nodes have the best prognosis. Recursive partitioning analysis identified 18 lymph nodes as the minimal number required for accurate staging. In patients who have 18 or more lymph nodes removed, survival is only predicted by the presence of nodal involvement and M1 disease.

CONCLUSION: Our analysis suggests that revisions of the current AJCC staging system for esophageal cancer should include N staging based on the number of involved lymph nodes and minimal requirements for the extent of lymphadenectomy.

This article has been cited by other articles:

				W. D. Bolton, W. L. Hofstetter, A. M. Francis, A. M. Correa, J. A. Ajani, M. S. Bhutani, J. Erasmus, R. Komaki, D. M. Maru, R. J. Mehran, et al. Impact of tumor length on long-term survival of pT1 esophageal adenocarcinoma J. Thorac. Cardiovasc. Surg., October 1, 2009; 138(4): 831 - 836. [Abstract] [Full Text] [PDF]

				P. C. Lee, J. L. Port, S. Paul, B. M. Stiles, and N. K. Altorki Predictors of long-term survival after resection of esophageal carcinoma with nonregional nodal metastases. Ann. Thorac. Surg., July 1, 2009; 88(1): 186 - 193. [Abstract] [Full Text] [PDF]

				C.-S. Lin, S.-C. Chang, Y.-H. Wei, T.-Y. Chou, Y.-C. Wu, H.-C. Lin, L.-S. Wang, and W.-H. Hsu Prognostic Variables in Thoracic Esophageal Squamous Cell Carcinoma Ann. Thorac. Surg., April 1, 2009; 87(4): 1056 - 1065. [Abstract] [Full Text] [PDF]

				J. M. Donahue, F. C. Nichols, Z. Li, D. A. Schomas, M. S. Allen, S. D. Cassivi, A. Jatoi, R. C. Miller, D. A. Wigle, K. R. Shen, et al. Complete pathologic response after neoadjuvant chemoradiotherapy for esophageal cancer is associated with enhanced survival. Ann. Thorac. Surg., February 1, 2009; 87(2): 392 - 398. [Abstract] [Full Text] [PDF]

				N. K. Veeramachaneni, J. B. Zoole, P. A. Decker, J. B. Putnam Jr, and B. F. Meyers Lymph Node Analysis in Esophageal Resection: American College of Surgeons Oncology Group Z0060 Trial Ann. Thorac. Surg., August 1, 2008; 86(2): 418 - 421. [Abstract] [Full Text] [PDF]