Assessment of cervical lymph node metastasis in the staging of thoracic esophageal carcinoma.
BACKGROUND
Cervical lymph node metastases (CLM) from esophageal carcinoma are regarded as a part of the M component of the TNM classification. Patients with CLM, however, can experience extended survival after cervical lymph node dissection, unlike patients with other M components.


METHODS
Among 844 patients with thoracic esophageal carcinoma, 197 underwent esophagectomy with three-field dissection of the cervical, mediastinal, and abdominal lymph nodes (3FD). The survival of patients with CLM was compared with that of patients with hematogenous metastasis (HM), and the prognostic value of CLM was assessed.


RESULTS
The survival curve for patients with CLM was significantly better than that for patients with HM (P = 0. 002). Among the 197 patients who underwent 3FD, 46 (23.4%) had histologic CLM. Of the 165 patients without hematogenous metastases, 22 (13.3%) had histologic CLM. The survival curve for the patients with histologic CLM was not significantly differ from that for patients with mediastinal or abdominal lymph node metastasis (P = 0. 127, P = 0.155) by univariate analyses.


CONCLUSIONS
The significantly better survival of patients with CLM compared with that of patients with HM strongly suggests that CLM carries a prognosis different from the other M components in the staging of thoracic esophageal carcinoma. Because the survival curve for patients after 3FD was similar to that of patients with metastasis in the mediastinum or abdomen, we feel CLM should be included in the N component.
Kato
H
H
Department of Surgery, National Cancer Center Hospital, Tokyo, Japan. hckato@ncc.go.jp
Igaki
H
H
Tachimori
Y
Y
Watanabe
H
H
Tsubosa
Y
Y
Nakanishi
Y
Y
D000328:Adult; D000368:Aged; D002277:Carcinoma / Q000401:mortality / Q000473:pathology* / Q000556:secondary*; D004938:Esophageal Neoplasms / Q000401:mortality* / Q000473:pathology*; D005260:Female; D006801:Humans; D008198:Lymph Nodes / Q000473:pathology*; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D009333:Neck; D009361:Neoplasm Invasiveness; D009367:Neoplasm Staging / Q000145:classification*; D011379:Prognosis; D012680:Sensitivity and Specificity; D016019:Survival Analysis; D015996:Survival Rate