title: Prognostic Significance of the Location of Lymph Node Metastases in Patients With Adenocarcinoma of the Distal Esophagus or Gastroesophageal Junction.
abstract: OBJECTIVE
  To identify the prognostic significance of the location of lymph node metastases in patients with esophageal or gastroesophageal junction (GEJ) adenocarcinoma treated with neoadjuvant therapy followed by esophagectomy.
  
  
  BACKGROUND
  Detection of lymph node metastases in the upper mediastinum and around the celiac trunk after neoadjuvant therapy and resection does not alter the TNM classification of esophageal carcinoma. The impact of these distant lymph node metastases on survival remains unclear.
  
  
  METHODS
  Between March 2003 and September 2013, 479 consecutive patients with adenocarcinoma of the distal esophagus or GEJ who underwent transthoracic esophagectomy with en bloc 2-field lymphadenectomy after neoadjuvant therapy were included, and survival was analyzed according to the location of positive lymph nodes in the resection specimen.
  
  
  RESULTS
  Two hundred fifty-three patients had nodal metastases in the resection specimen. Of these patients, 92 patients had metastases in locoregional nodes, 114 patients in truncal nodes, 21 patients in the proximal field of the chest, and 26 patients had both positive truncal and proximal field nodes. Median disease-free survival was 170 months in the absence of nodal metastases, 35 months for metastases limited to locoregional nodes, 16 months for positive truncal nodes, 15 months for positive nodes in the proximal field, and 8 months for nodal metastases in both truncal and the proximal field. On multivariate analysis, location of lymph node metastases was independently associated with survival.
  
  
  CONCLUSIONS
  Location of lymph node metastases is an independent predictor for survival. Relatively distant lymph node metastases along the celiac axis and/or the proximal field have a negative impact on survival. Location of lymph node metastases should therefore be considered in future staging systems of esophageal and GEJ adenocarcinoma.
authors.affiliation: *Department of Surgery, Academic Medical Center, Amsterdam, the Netherlands†Northern Oesophago-Gastric Cancer Unit, Royal Victoria Infirmary, Newcastle-Upon-Tyne,UK‡Department of Pathology, Academic Medical Center, Amsterdam, the Netherlands§Department of Radiation Oncology, Academic Medical Center, Amsterdam, the Netherlands¶Department of Gastroenterology, Academic Medical Center, Amsterdam, the Netherlands||Department of Medical Oncology, Academic Medical Center, Amsterdam, the Netherlands.
authors.forename: Maarten C J
authors.initials: MC
authors.lastname: Anderegg
authors.forename: Sjoerd M
authors.initials: SM
authors.lastname: Lagarde
authors.forename: Vamshi P
authors.initials: VP
authors.lastname: Jagadesham
authors.forename: Suzanne S
authors.initials: SS
authors.lastname: Gisbertz
authors.forename: Arul
authors.initials: A
authors.lastname: Immanuel
authors.forename: Sybren L
authors.initials: SL
authors.lastname: Meijer
authors.forename: Maarten C C M
authors.initials: MC
authors.lastname: Hulshof
authors.forename: Jacques J G H M
authors.initials: JJ
authors.lastname: Bergman
authors.forename: Hanneke W M
authors.initials: HW
authors.lastname: van Laarhoven
authors.forename: S Michael
authors.initials: SM
authors.lastname: Griffin
authors.forename: Mark I
authors.initials: MI
authors.lastname: van Berge Henegouwen
mesh_terms: D000230:Adenocarcinoma / Q000401:mortality / Q000556:secondary* / Q000628:therapy*; D000368:Aged; D059248:Chemoradiotherapy; D018572:Disease-Free Survival; D004938:Esophageal Neoplasms / Q000401:mortality / Q000556:secondary* / Q000628:therapy*; D016629:Esophagectomy; D004943:Esophagogastric Junction; D005260:Female; D006801:Humans; D008197:Lymph Node Excision; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D009367:Neoplasm Staging