Impact of the number and extent of positive lymph nodes in 200 patients with thoracic esophageal squamous cell carcinoma after three-field lymph node dissection.
BACKGROUND
Subtotal esophagectomy with three-field lymph node dissection (3FLD) has been reported to improve survival in patients with thoracic esophageal squamous cell carcinoma (SCC). The purpose of this study was to evaluate the prognostic impact of the extent and number of positive lymph nodes for long-term survival of patients who underwent 3FLD.


METHODS
From January 1983 to December 2002, a total of 200 patients with thoracic esophageal SCC underwent 3FLD without any neoadjuvant therapy. The prognostic impact of the extent and number of positive lymph nodes was evaluated by both univariate and multivariate analysis.


RESULTS
The extent of positive nodes associated with a 5-year survival were as follows: none, 69%; one-field, 50%; two-field, 29%; and three-field, 11%. The number of positive nodes associated with 5-year survival were as follows: single node, 65%; two-nodes, 51%; and more than three-nodes, 20%. Among patients with cervical lymphatic spreading, patients with upper tumors showed significantly better survival than patients with lower tumors (P=0.036). Multivariate analysis indicated that number of positive nodes and the abdominal node status were independent prognostic factors among lymph node status.


CONCLUSIONS
Together, number and extent of positive lymph nodes can be considered an independent predictor of a high risk of recurrence. Although cervical lymphatic spreading was risk factor for worse survival, patients with upper tumors may have survival benefit after cervical lymph node dissection.
Shimada
Hideaki
H
Department of Frontier Surgery, Chiba University Graduate School of Medicine, Chiba, Japan. hshimada@faculty.chiba-u.jp
Okazumi
Shin-ichi
S
Matsubara
Hisahiro
H
Nabeya
Yoshihiro
Y
Shiratori
Tooru
T
Shimizu
Takanori
T
Shuto
Kiyohiko
K
Hayashi
Hideki
H
Ochiai
Takenori
T
D000005:Abdomen; D000328:Adult; D000368:Aged; D002294:Carcinoma, Squamous Cell / Q000473:pathology* / Q000601:surgery; D004938:Esophageal Neoplasms / Q000473:pathology* / Q000601:surgery; D016629:Esophagectomy; D005260:Female; D006801:Humans; D008197:Lymph Node Excision; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D009333:Neck; D009367:Neoplasm Staging; D011379:Prognosis; D016019:Survival Analysis; D013909:Thorax