title: Strong impact of micrometastatic tumor cell load in patients with esophageal carcinoma.
abstract: BACKGROUND
  To assess the role of immunohistochemically detectable nodal microinvolvement of patients with "curatively" resected esophageal carcinoma.
  
  
  METHODS
  In 73 patients with resectable esophageal carcinoma [squamous cell carcinoma (SCC), n = 45 (61.6%); adenocarcinoma (AC), n = 28 (38.4%)] a total of 2174 lymph nodes (LN) were removed. In each of the 1958 LN classified as negative on conventional histopathology, immunohistochemistry was performed using the anticytokeratin antibody AE1/AE3. To determine the role of the amount of residual tumor load, the patients were grouped according to the percentage of LN affected with micrometastasis (0%, <11%, and > or =11%).
  
  
  RESULTS
  Tumor cells were immunohistochemically detected in 47 LN (2.4%) from 25 (34.2%) patients. Five-year overall survival probability (5-YSP) of 30% in pN(0 )patients with detected occult tumor cells in LN was significantly worse than that in those without nodal microinvolvement (76%, P = 0.021), hereby resembling that of pN1-patients (24%, P = 0.84). Median overall survival in patients with no (0%), low (<11%), and high (>11%) micrometastatic tumor load was 43, 27, and 11 months, respectively. Substratification according to histological type showed that, in patients with AC, the presence of nodal microinvolvement had a significant impact on 5-YSP (0% versus 65%; P = 0.03), whereas in patients with SCC, differences of 5-YSP were only of borderline significance (24% versus 53%; P = 0.081).
  
  
  CONCLUSIONS
  Minimal tumor cell load as assessed by the ratio of micrometastatically affected LN is a complementary tool for better risk stratification of patients with esophageal carcinoma.
authors.affiliation: Department of General, Visceral and Thoracic Surgery, University Medical Centre of Hamburg-Eppendorf, Germany. akoenig@uke.uni-hamburg.de
authors.forename: Alexandra M
authors.initials: AM
authors.lastname: Koenig
authors.forename: Klaus L
authors.initials: KL
authors.lastname: Prenzel
authors.forename: Dean
authors.initials: D
authors.lastname: Bogoevski
authors.forename: Emre F
authors.initials: EF
authors.lastname: Yekebas
authors.forename: Michael
authors.initials: M
authors.lastname: Bubenheim
authors.forename: Lucia
authors.initials: L
authors.lastname: Faithova
authors.forename: Yogesh K
authors.initials: YK
authors.lastname: Vashist
authors.forename: Karim A
authors.initials: KA
authors.lastname: Gawad
authors.forename: Stephan E
authors.initials: SE
authors.lastname: Baldus
authors.forename: Klaus
authors.initials: K
authors.lastname: Pantel
authors.forename: Paul M
authors.initials: PM
authors.lastname: Schneider
authors.forename: Arnulf H
authors.initials: AH
authors.lastname: Hölscher
authors.forename: Jakob R
authors.initials: JR
authors.lastname: Izbicki
mesh_terms: D000230:Adenocarcinoma / Q000556:secondary*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D014408:Biomarkers, Tumor / Q000378:metabolism; D002294:Carcinoma, Squamous Cell / Q000556:secondary*; D016022:Case-Control Studies; D018450:Disease Progression; D004938:Esophageal Neoplasms / Q000473:pathology* / Q000601:surgery; D016629:Esophagectomy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007124:Immunoenzyme Techniques; D007633:Keratins / Q000276:immunology / Q000378:metabolism; D008198:Lymph Nodes / Q000473:pathology* / Q000601:surgery; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D009364:Neoplasm Recurrence, Local / Q000473:pathology*; D009367:Neoplasm Staging; D011379:Prognosis; D015996:Survival Rate
chemical_list: D014408:Biomarkers, Tumor; D007633:Keratins