title: Ratio of metastatic lymph nodes to total number of nodes resected is prognostic for survival in esophageal carcinoma.
abstract: BACKGROUND
  The role of the number of metastatic nodes in esophageal cancer surgery is of interest. We assess predictors of survival after oesophagectomy for esophageal and gastroesophageal junction malignancy.
  
  
  METHODS
  Prospective data of consecutive patients undergoing oesophagectomy and systematic lymphadenectomy between 1991 and 2007.
  
  
  RESULTS
  Of 224 patients, 148 patients (66%) had adenocarcinoma, 70 (31%) squamous cell carcinoma, and 6 (2.6%) were other tumor types. Five-year survival was 43% with hospital mortality of 3.5%. Locoregional recurrence occurred in 14%. The total number of affected nodes significantly reduced survival (four or more metastatic nodes). Further analysis of the ratio of nodes affected to the total number resected showed a significant decrease in survival as the percentage of positive nodes increased (p < 0.001).
  
  
  CONCLUSIONS
  Patients undergoing surgery for esophageal cancer should be staged according to a minimum total number of metastatic lymph nodes and ratios because this more accurately predicts survival than current staging systems.
authors.affiliation: Department of Upper GI Surgery, Concord Repatriation General Hospital, University of Sydney, Strathfield Private Hospital Campus, Sydney, New South Wales, Australia. clive.kelty@bigfoot.com
authors.forename: Clive J
authors.initials: CJ
authors.lastname: Kelty
authors.forename: Catherine W
authors.initials: CW
authors.lastname: Kennedy
authors.forename: Gregory L
authors.initials: GL
authors.lastname: Falk
mesh_terms: D000230:Adenocarcinoma / Q000401:mortality* / Q000556:secondary / Q000601:surgery; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002294:Carcinoma, Squamous Cell / Q000401:mortality* / Q000556:secondary / Q000601:surgery; D004938:Esophageal Neoplasms / Q000401:mortality* / Q000473:pathology / Q000601:surgery; D016629:Esophagectomy; D005260:Female; D006801:Humans; D008197:Lymph Node Excision; D008198:Lymph Nodes / Q000473:pathology* / Q000601:surgery; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011379:Prognosis; D011446:Prospective Studies; D015996:Survival Rate