title: Prognostic value of immunohistochemically identifiable tumor cells in lymph nodes of patients with completely resected esophageal cancer.
abstract: BACKGROUND
  Current methods of disease staging often fail to detect small numbers of tumor cells in lymph nodes. Metastatic relapse may arise from these few cells.
  
  
  METHODS
  We studied 1308 lymph nodes from 68 patients with esophageal cancer without overt metastases who had undergone radical en bloc esophagectomy. A total of 399 lymph nodes obtained from 68 patients were found to be free of tumor by routine histopathological analysis and were studied further for isolated tumor cells by immunohistochemical analysis with the monoclonal anti-epithelial-cell antibody Ber-EP4. This antibody did not stain lymph nodes from 24 control patients without carcinoma.
  
  
  RESULTS
  Of the 399 "tumor free" lymph nodes, 67 (17 percent), obtained from 42 of the 68 patients, contained Ber-EP4-positive tumor cells. Fifteen of 30 patients who were considered free of lymph-node metastases by histopathological analysis had such cells in their lymph nodes, and 5 of the 15 had small primary tumors. Ber-EP4-positive cells found in "tumor free" nodes were independently predictive of significantly reduced relapse-free survival (P=0.008) and overall survival (P=0.03). They predicted relapse both in patients without nodal metastases (P=0.01) and in those with regional lymph-node involvement (P=0.007). All 12 patients whose lymph nodes were negative on both histopathological and immunohistochemical analysis and who were available for follow-up survived without recurrence. The presence of micrometastatic tumor cells in bone marrow had no additional prognostic value.
  
  
  CONCLUSIONS
  Immunohistochemical examination of lymph nodes may improve the pathological staging of esophageal cancer.
authors.affiliation: Abteilung für Allgemeinchirurgie, Universitätskrankenhaus Eppendorf, Hamburg, Germany.
authors.forename: J R
authors.initials: JR
authors.lastname: Izbicki
authors.forename: S B
authors.initials: SB
authors.lastname: Hosch
authors.forename: U
authors.initials: U
authors.lastname: Pichlmeier
authors.forename: A
authors.initials: A
authors.lastname: Rehders
authors.forename: C
authors.initials: C
authors.lastname: Busch
authors.forename: A
authors.initials: A
authors.lastname: Niendorf
authors.forename: B
authors.initials: B
authors.lastname: Passlick
authors.forename: C E
authors.initials: CE
authors.lastname: Broelsch
authors.forename: K
authors.initials: K
authors.lastname: Pantel
mesh_terms: D000230:Adenocarcinoma / Q000473:pathology / Q000556:secondary; D000328:Adult; D000368:Aged; D002294:Carcinoma, Squamous Cell / Q000473:pathology / Q000556:secondary; D018572:Disease-Free Survival; D004938:Esophageal Neoplasms / Q000473:pathology* / Q000601:surgery; D005260:Female; D006801:Humans; D008198:Lymph Nodes / Q000473:pathology*; D008207:Lymphatic Metastasis / Q000175:diagnosis*; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D009367:Neoplasm Staging / Q000379:methods*; D011379:Prognosis; D011446:Prospective Studies