The assessment of prognosis of surgically resected oesophageal cancer is dependent on the number of lymph nodes examined pathologically.
OBJECTIVE
The prognosis in surgically resected oesophageal carcinoma (OC) is dependent on the number of regional lymph nodes (LN) involved, but no guidance exists on how many LNs should be examined histopathologically to give a reliable pN status. The aim of this study was to determine whether the number of LNs examined after OC resection has a significant effect on the assessment of prognosis.


RESULTS
Routinely generated pathology reports from 237 consecutive patients undergoing oesophagectomy for OC were examined and analysed in relation to survival. The main outcome measure was survival from date of diagnosis. Lymph node count (LNC) correlated strongly with survival; a plateau was reached after a count of 10. Median and 2-year survival was 30 months and 42%, respectively, if <10 nodes were examined (n = 88), compared with 51 months and 61% if >10 nodes were examined (P = 0.005). This effect was greatest in pN0 cases. The prognostic value of the absolute number of LN metastases (<4) and LN ratio (<0.4) was strongly dependent on a LNC of >10.


CONCLUSIONS
These results demonstrate the importance of careful pathological examination and lymph node retrieval after OC resection. At least 10 nodes should be examined to designate an OC as pN0.
Twine
Christopher P
CP
South East Wales Cancer Network, Department of General and Upper GI Surgery, University Hospital of Wales, Cardiff Cardiff, UK.
Lewis
Wyn G
WG
Morgan
Matthew A
MA
Chan
David
D
Clark
Geoffrey W B
GW
Havard
Tim
T
Crosby
Tom D
TD
Roberts
S Ashley
SA
Williams
Geriant T
GT
D000230:Adenocarcinoma / Q000175:diagnosis* / Q000401:mortality / Q000473:pathology*; D002294:Carcinoma, Squamous Cell / Q000175:diagnosis* / Q000401:mortality / Q000473:pathology*; D003951:Diagnostic Errors / Q000517:prevention & control; D004938:Esophageal Neoplasms / Q000175:diagnosis* / Q000401:mortality / Q000473:pathology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008198:Lymph Nodes / Q000473:pathology*; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies; D015996:Survival Rate