title: Prognostic impact of nodal micrometastasis in early esophageal cancer.
abstract: BACKGROUND
  Nodal micrometastasis is a negative prognosticator for esophageal cancer. There is a trend toward endoscopic resection for early cancer of the esophagus without lymphadenectomy. Frequency and prognostic impact of nodal micrometastasis in early cancer of the esophagus have not been investigated so far.
  
  
  METHODS
  This study includes 69 patients with a pT1-stage cancer of the esophagus (SCC: n = 26, AC: n = 43), who underwent transthoracic en-bloc esophagectomy with D2-lympadenectomy between 1996 and 2004. On routine histopathological analysis 48 patients were diagnosed as pN0. Lymph nodes (n = 1344) of these patients were further examined for the presence of isolated tumor cells with the monoclonal anti-epithelial antibody AE1/AE3.
  
  
  RESULTS
  In lymph nodes of 7 (14.6%) out of 48 pN0-patients a positive staining for AE1/AE3 as a sign for nodal micrometastasis was found. In these patients the tumor has infiltrated the submucosal layer. In patients with tumors restricted to mucosal layer (n = 20) no nodal micrometastasis was present. 5-year survival of pN0-patients with nodal micrometastasis was inferior compared to pN0-patients (57% vs. 82%; p = 0.002).
  
  
  CONCLUSIONS
  Almost 15% of patients with pT1 N0 M0 carcinoma of the esophagus and only those with submucosal infiltration show nodal micrometastasis. It has a significant negative impact on survival already in early esophageal cancer.
authors.affiliation: Department of General, Visceral and Cancer Surgery, University of Cologne, Germany.
authors.forename: K L
authors.initials: KL
authors.lastname: Prenzel
authors.forename: A H
authors.initials: AH
authors.lastname: Hölscher
authors.forename: U
authors.initials: U
authors.lastname: Drebber
authors.forename: M
authors.initials: M
authors.lastname: Agavonova
authors.forename: C A
authors.initials: CA
authors.lastname: Gutschow
authors.forename: E
authors.initials: E
authors.lastname: Bollschweiler
mesh_terms: D000230:Adenocarcinoma / Q000401:mortality / Q000473:pathology* / Q000601:surgery; D002294:Carcinoma, Squamous Cell / Q000401:mortality / Q000473:pathology* / Q000601:surgery; D004938:Esophageal Neoplasms / Q000401:mortality / Q000473:pathology* / Q000601:surgery; D016629:Esophagectomy; D005260:Female; D005858:Germany / Q000453:epidemiology; D006801:Humans; D008197:Lymph Node Excision; D008207:Lymphatic Metastasis / Q000473:pathology; D008297:Male; D061206:Neoplasm Micrometastasis / Q000473:pathology*; D009367:Neoplasm Staging; D011379:Prognosis; D021701:Sentinel Lymph Node Biopsy; D016019:Survival Analysis