title: Prognostic impact of lymph node involvement and the extent of lymphadenectomy (LAD) in adenocarcinoma of the esophagogastric junction (AEG).
abstract: BACKGROUND
  The prognostic importance of lymph node (LN) involvement for patients with adenocarcinoma of the esophagogastric junction (AEG) is well-known. In the latest edition of the UICC staging system, the number of metastatic LNs was taken into account, while the extent of lymphadenectomy (LAD) remains unaddressed. Removal of at least six LNs is recommended, but there is no defined minimum number as to classify as (y)pN0. We examined the prognostic value of the number of positive LNs, number of LNs removed, and LN ratio (LNR) in order to determine the influence of an adequate LAD on overall survival (OS).
  
  
  METHODS
  We analyzed data of 316 patients with AEG treated in our institution (2001-2011) regarding clinicopathological data, treatment, morbidity, mortality, and long-term prognosis. Univariate and multivariate analysis was performed using Cox regression to evaluate the prognostic impact of(y)pN category, number of LNs removed and LNR.
  
  
  RESULTS
  OS decreased with higher count of positive LNs (p < 0.001) and higher LNR (p < 0.001). Whether >6, >15, or >30 LNs were removed did not influence OS, neither in the entire study population nor within individual (y)pT or (y)pN categories. Multivariate analysis revealed LNR (p < 0.001) besides M category (p = 0.015) and tracheotomy during the postoperative course (p = 0.005) as independent predictors of OS.
  
  
  CONCLUSIONS
  The classification according to the number of involved LNs in the latest edition of the UICC staging system improves prognostication in patients with AEG. The importance of an adequate LAD is shown by the high prognostic relevance of the LNR rather than the absolute number of LNs removed.
authors.affiliation: Department of Surgery, University Hospital Heidelberg, INF 110, 69120, Heidelberg, Germany, Leila.Sisic@med.uni-heidelberg.de.
authors.forename: Leila
authors.initials: L
authors.lastname: Sisic
authors.forename: Susanne
authors.initials: S
authors.lastname: Blank
authors.forename: Wilko
authors.initials: W
authors.lastname: Weichert
authors.forename: Dirk
authors.initials: D
authors.lastname: Jäger
authors.forename: Christoph
authors.initials: C
authors.lastname: Springfeld
authors.forename: Marcel
authors.initials: M
authors.lastname: Hochreiter
authors.forename: Markus
authors.initials: M
authors.lastname: Büchler
authors.forename: Katja
authors.initials: K
authors.lastname: Ott
mesh_terms: D000230:Adenocarcinoma / Q000401:mortality / Q000556:secondary* / Q000601:surgery*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004938:Esophageal Neoplasms / Q000401:mortality / Q000473:pathology* / Q000601:surgery*; D016629:Esophagectomy; D004943:Esophagogastric Junction; D005260:Female; D006801:Humans; D008197:Lymph Node Excision; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies; D015996:Survival Rate