Abstract
Background
Microscopic cancer spreading to extranodal connective tissues (extranodal spreading: ENS) is occasionally found in resected specimens from patients with esophageal squamous cell carcinoma (SCC), but the prognostic impact of ENS remains unclear. The aims of this study were to elucidate the prognostic impact of ENS to help determine the most suitable management for the patients with ENS.
Methods
We histologically re-evaluated 7,349 lymph nodes obtained from 171 patients with SCC of the thoracic esophagus who underwent potentially curable resection between 1992 and 2003. We defined ENS as microscopic penetration of tumor cells from metastatic lymph nodes or tumor cell dissemination into extranodal connective tissues.
Results
Extranodal spreading was found in 37 (21.6%) patients, and it had a significant relationship with diameter and depth of the tumor, lymphatic and venous invasion, intramural metastasis, and number of metastatic nodes. Patients who were ENS positive were at higher risk of recurrence, and their overall survival rate was lower than that for ENS-negative patients. Furthermore, recurrent risk was higher and overall survival rate was lower in ENS-positive patients than in ENS-negative patients when they had 1–3 metastatic nodes, but recurrent risk and overall survival rate of the patients with 4 or more metastatic nodes were very similar in ENS-positive and ENS-negative patients.
Conclusions
The present findings suggest that in SCC of the thoracic esophagus, the presence of ENS increases recurrent risk and reduces the overall survival of the patients with 1–3 metastatic nodes. Patients showing ENS should be managed in the same way as patients with 4 or more metastatic nodes.
Similar content being viewed by others
References
Nishimaki T, Suzuki T, Suzuki S, et al. (1998) Outcomes of extended radical esophagectomy for thoracic esophageal cancer. J Am Coll Surg 186:306–312
Baba M, Aikou T, Yoshinaka H, et al. (1994) Long-term results of subtotal esophagectomy with three-field lymphadenectomy for carcinoma of the thoracic esophagus. Ann Surg 219:310–316
Wenzel S, Sagowski C, Kehrl W, et al. (2004) The prognostic impact of metastatic pattern of lymph nodes in patients with oral and oropharyngeal squamous cell carcinomas. Eur Arch Otorhinolaryngol 261:270–275
Jeffrey NM, Jayson SG, Mo V, et al. (2001) Extracapsular spread. A significant predictor of treatment failure in patients with squamous cell carcinoma of the tongue. Cancer 92: 3030–3036
Steinhart H, Schroeder HG, Buchta B, et al. (1994) Prognostic significance of extra-capsular invasion in cervical lymph node metastases of squamous epithelial carcinoma. Laryngorhinootologie 73:620–625
Yamashita H, Noguchi S, Murakami N, et al. (1997) Extracapsular invasion of lymph node metastasis is an indicator of distant metastasis and poor prognosis in patients with thyroid papillary carcinoma. Cancer 80:2268–2272
Leonard C, Corkill M, Tompkin J, et al. (1995) Are axillary recurrence and overall survival affected by axillary extranodal tumor extension in breast cancer? Implications for radiation therapy. J Clin Oncol 13:47–53
Suemasu K, Naruke T (1982) Prognostic significance of extranodal cancer invasion of mediastinal lymph nodes in lung cancer. Jpn J Clin Oncol 12:207–212
Koike H, Ichikawa D, Kitamura K et al. (2004) Perinodal involvement of cancer cells in gastric cancer patients. Surgery 135:266–272
Kumagai K, Tanaka T, Yamagata K et al. (2001) Liver metastasis in gastric cancer with particular reference to lymphatic advancement. Gastric Cancer 4:150–155
Tanaka T, Kumagai K, Shimizu K, et al. (2000) Peritoneal metastasis in gastric cancer with particular reference to lymphatic advancement; extranodal invasion is a significant risk factor for peritoneal metastasis. J Surg Oncol 75:165–171
Baba M, Aikou T, Natsugoe S, et al. (1997) Lymph node and perinodal tissue tumor involvement in patients with esophagectomy and three-field lymphadenectomy for carcinoma of the esophagus. J Surg Oncol 64:12–6
Japanese Society for Esophageal Diseases (1999) Guidelines for Clinical and Pathologic Studies on Carcinoma of the Esophagus, 9th edition, Japanese Society for Esophageal Disease, 2–58
Sobin LH, Wittekind C, eds. (1997) TNM Classification of Malignant Tumours, 5th Edition, New York, Wiley-Liss, 51–58
Gatzinsky P, Berglin E, Dernevik L, et al. (1985) Resectional operations and long-term results in carcinoma of the esophagus. J Thorac Cardiovasc Surg 89:71–76
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Tanabe, T., Kanda, T., Kosugi, Si. et al. Extranodal Spreading of Esophageal Squamous Cell Carcinoma: Clinicopathological Characteristics and Prognostic Impact. World J Surg 31, 2192–2198 (2007). https://doi.org/10.1007/s00268-007-9204-2
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00268-007-9204-2