Skip to main content

Advertisement

SpringerLink
Log in

The significance of lymph node status as a prognostic factor for esophageal cancer

  • Review Article
  • Published:
Surgery Today Aims and scope Submit manuscript

Abstract

The revision of the TNM Classification of Malignant Tumors, 7th Edition, suggests the lymph node (LN) status to be the most significant risk factor in esophageal cancer. This article reviews the current status of LNs as indicators of prognosis. The significance of the number of metastatic LNs, the number of resected LNs, and a novel index, the “LN ratio” (metastatic LNs/removed LNs) in patients with esophageal cancer, were reviewed. The number of metastatic LNs independently predicted the prognosis of both overall survival and relapse-free survival. The number of positive LNs was also the best predictive marker of survival. Furthermore, overall survival significantly depended on the number of surgically removed LNs, and the LN ratio closely correlated with survival. The LN status is considered to be the most significant information that can be used to predict the prognosis. However, there are many issues that still need to be resolved. Better knowledge of the N-status is therefore needed to effectively utilize this information. Further research should focus on the N-status of patients with esophageal cancer.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Zhang HL, Chen LQ, Liu RL, et al. The number of lymph node metastases influences survival and International Union Against Cancer tumor-node-metastasis classification for esophageal squamous cell carcinoma. Dis Esophagus 2010;23(1):53–58.

    Article  PubMed  CAS  Google Scholar 

  2. Kunisaki C, Makino H, Kimura J, et al. Impact of lymph-node metastasis site in patients with thoracic esophageal cancer. J Surg Oncol 2010;101(1):36–42.

    Article  PubMed  Google Scholar 

  3. Lin CS, Chang SC, Wei YH, et al. Prognostic variables in thoracic esophageal squamous cell carcinoma. Ann Thorac Surg 2009;87(4):1056–1065.

    Article  PubMed  Google Scholar 

  4. Natsugoe S, Matsumoto M, Okumura H, et al. Prognostic factors in patients with submucosal esophageal cancer. J Gastrointest Surg 2004;8(5):631–635.

    Article  PubMed  Google Scholar 

  5. Sun K, Zhang R, Zhang D, et al. Prognostic significance of lymph node metastasis in surgical resection of esophageal cancer. Chin Med J (Engl) 1996;109(1):89–92.

    CAS  Google Scholar 

  6. Shim YM, Choi YS, Kim K. Prognosis after surgical resection of M1a/M1b esophageal squamous cell carcinoma. J Korean Med Sci 2005;20(2):229–231.

    Article  PubMed  Google Scholar 

  7. Hsu WH, Hsu PK, Hsieh CC, et al. The metastatic lymph node number and ratio are independent prognostic factors in esophageal cancer. J Gastrointest Surg 2009;13(11):1913–1920.

    Article  PubMed  Google Scholar 

  8. Liu YP, Ma L, Wang SJ, et al. Prognostic value of lymph node metastases and lymph node ratio in esophageal squamous cell carcinoma. Eur J Surg Oncol 2009;36(2):155–159.

    PubMed  CAS  Google Scholar 

  9. Japanese Society for Esophageal Disease. Japanese classification of esophageal cancer. Tokyo: Kanehara; 2008.

    Google Scholar 

  10. Leslie H. Sobin, Mary K. Gospodarowicz, Christian Wittekind. TNM classification of malignant tumours (UICC International Union Against Cancer). Wiley-Blackwell; 2009.

  11. Edge SB, Byrd DR, Compton CC. AJCC cancer staging manual. 7th ed. Berlin Heidelberg New York: Springer; 2010.

    Google Scholar 

  12. Sobin LH, Wittekind CH. UICC TNM classification of malignant tumor. New York: Wiley; 2002. p. 60–64.

    Google Scholar 

  13. Greene FL, Page DL, Fleming ID. AJCC cancer staging manual. Berlin Heidelberg New York: Springer; 2002.

    Book  Google Scholar 

  14. Urschel JD, Vasan H. A meta-analysis of randomized controlled trials that compared neoadjuvant chemoradiation and surgery to surgery alone for resectable esophageal cancer. Am J Surg 2003;185(6):538–543.

    Article  PubMed  Google Scholar 

  15. Urschel JD, Vasan H, Blewett CJ. A meta-analysis of randomized controlled trials that compared neoadjuvant chemotherapy and surgery to surgery alone for resectable esophageal cancer. Am J Surg 2002;183(3):274–279.

    Article  PubMed  Google Scholar 

  16. Burmeister BH, Smithers BM, Gebski V, et al. Surgery alone versus chemoradiotherapy followed by surgery for resectable cancer of the oesophagus: a randomised controlled phase III trial. Lancet Oncol 2005;6(9):659–668.

    Article  PubMed  Google Scholar 

  17. Gebski V, Burmeister B, Smithers BM, et al. Survival benefits from neoadjuvant chemoradiotherapy or chemotherapy in oesophageal carcinoma: a meta-analysis. Lancet Oncol 2007;8(3):226–234.

    Article  PubMed  CAS  Google Scholar 

  18. Akutsu Y, Matsubara H, Shuto K, et al. Clinical and pathologic evaluation of the effectiveness of neoadjuvant chemoradiation therapy in advanced esophageal cancer patients. World J Surg 2009;33(5):1002–1009.

    Article  PubMed  Google Scholar 

  19. Donahue JM, Nichols FC, Li Z, et al. Complete pathologic response after neoadjuvant chemoradiotherapy for esophageal cancer is associated with enhanced survival. Ann Thorac Surg 2009;87(2):392–398; discussion 398–9.

    Article  PubMed  Google Scholar 

  20. Stiles BM, Christos P, Port JL, et al. Predictors of survival in patients with persistent nodal metastases after preoperative chemotherapy for esophageal cancer. J Thorac Cardiovasc Surg 2010;139(2):387–394.

    Article  PubMed  Google Scholar 

  21. Chirieac LR, Swisher SG, Ajani JA, et al. Posttherapy pathologic stage predicts survival in patients with esophageal carcinoma receiving preoperative chemoradiation. Cancer 2005;103(7):1347–1355.

    Article  PubMed  Google Scholar 

  22. Schroder W, Baldus SE, Monig SP, et al. Lymph node staging of esophageal squamous cell carcinoma in patients with and without neoadjuvant radiochemotherapy: histomorphologic analysis. World J Surg 2002;26(5):584–587.

    Article  PubMed  Google Scholar 

  23. Mariette C, Piessen G, Briez N, et al. The number of metastatic lymph nodes and the ratio between metastatic and examined lymph nodes are independent prognostic factors in esophageal cancer regardless of neoadjuvant chemoradiation or lymphadenectomy extent. Ann Surg 2008;247(2):365–371.

    Article  PubMed  Google Scholar 

  24. Gu Y, Swisher SG, Ajani JA, et al. The number of lymph nodes with metastasis predicts survival in patients with esophageal or esophagogastric junction adenocarcinoma who receive preoperative chemoradiation. Cancer 2006;106(5):1017–1025.

    Article  PubMed  Google Scholar 

  25. Miyata H, Yamasaki M, Takiguchi S, et al. Pre- and post-therapy nodal status equally affects survival of patients with oesophageal squamous cell carcinoma receiving preoperative chemoradiation. Oncol Rep 2010;23(5):1331–1337.

    Article  PubMed  Google Scholar 

  26. Nakagawa S, Kanda T, Kosugi S, et al. Recurrence pattern of squamous cell carcinoma of the thoracic esophagus after extended radical esophagectomy with three-field lymphadenectomy. J Am Coll Surg 2004;198(2):205–211.

    Article  PubMed  Google Scholar 

  27. Ando N, Iizuka T, Ide H, et al. Surgery plus chemotherapy compared with surgery alone for localized squamous cell carcinoma of the thoracic esophagus: a Japan Clinical Oncology Group Study — JCOG9204. J Clin Oncol 2003;21(24):4592–4596.

    Article  PubMed  Google Scholar 

  28. Tanaka Y, Yoshida K, Sanada Y, et al. Biweekly docetaxel, cisplatin, and 5-fluorouracil (DCF) chemotherapy for advanced esophageal squamous cell carcinoma: a phase I dose-escalation study. Cancer Chemother Pharmacol 2010;66(6):1159–1165.

    Article  PubMed  CAS  Google Scholar 

  29. Igaki H, Kato H, Ando N. A randomized trial of postoperative adjuvant chemotherapy versus neoadjuvant chemotherapy for clinical stage II/III squamous cell carcinoma of esophgus. J Clin Oncol 2008;26 (ASCO Meeting Proceedings Supplement):4510.

    Google Scholar 

  30. Twine CP, Lewis WG, Morgan MA, et al. The assessment of prognosis of surgically resected oesophageal cancer is dependent on the number of lymph nodes examined pathologically. Histopathology 2009;55(1):46–52.

    Article  PubMed  Google Scholar 

  31. Groth SS, Virnig BA, Whitson BA, et al. Determination of the minimum number of lymph nodes to examine to maximize survival in patients with esophageal carcinoma: data from the Surveillance Epidemiology and End Results database. J Thorac Cardiovasc Surg 2010;139(3):612–620.

    Article  PubMed  Google Scholar 

  32. Chen YJ, Schultheiss TE, Wong JY, et al. Impact of the number of resected and involved lymph nodes on esophageal cancer survival. J Surg Oncol 2009;100(2):127–132.

    Article  PubMed  Google Scholar 

  33. Schwarz RE, Smith DD. Clinical impa ct of lymphadenectomy extent in resectable esophageal cancer. J Gastrointest Surg 2007;11(11):1384–1393; discussion 1393–4.

    Article  PubMed  Google Scholar 

  34. Peyre CG, Hagen JA, DeMeester SR, et al. The number of lymph nodes removed predicts survival in esophageal cancer: an international study on the impact of extent of surgical resection. Ann Surg 2008;248(4):549–556.

    PubMed  Google Scholar 

  35. Yang HX, Xu Y, Fu JH, et al. An evalua tion of the number of lymph nodes examined and survival for node-negative esophageal carcinoma: data from China. Ann Surg Oncol 2010;17(7):1901–1911.

    Article  PubMed  Google Scholar 

  36. Altorki NK, Zhou XK, Stiles B, et al. T otal number of resected lymph nodes predicts survival in esophageal cancer. Ann Surg 2008;248(2):221–226.

    Article  PubMed  Google Scholar 

  37. Bogoevski D, Onken F, Koenig A, et al. I s it time for a new TNM classification in esophageal carcinoma? Ann Surg 2008;247(4):633–641.

    Article  PubMed  Google Scholar 

  38. Isono K, Sato H, Nakayama K. Results of a nationwide study on the three-field lymph node dissection of esophageal cancer. Oncology 1991;48(5):411–420.

    Article  PubMed  CAS  Google Scholar 

  39. Rizk NP, Venkatraman E, Bains MS, et al. A merican Joint Committee on Cancer staging system does not accurately predict survival in patients receiving multimodality therapy for esophageal adenocarcinoma. J Clin Oncol 2007;25(5):507–512.

    Article  PubMed  Google Scholar 

  40. Stein HJ, von Rahden BH, Siewert JR. Surviv al after oesophagectomy for cancer of the oesophagus. Langenbecks Arch Surg 2005;390(4):280–285.

    Article  PubMed  Google Scholar 

  41. Martin DJ, Church NG, Kennedy CW, et al. Doe s systematic 2-field lymphadenectomy for esophageal malignancy offer a survival advantage? Results from 178 consecutive patients. Dis Esophagus 2008;21(7):612–618.

    Article  PubMed  CAS  Google Scholar 

  42. Greenstein AJ, Litle VR, Swanson SJ, et al. P rognostic significance of the number of lymph node metastases in esophageal cancer. J Am Coll Surg 2008;206(2):239–246.

    Article  PubMed  Google Scholar 

  43. Korst RJ, Rusch VW, Venkatraman E, et al. Prop osed revision of the staging classification for esophageal cancer. J Thorac Cardiovasc Surg 1998;115(3):660–669; discussion 669–70.

    Article  PubMed  CAS  Google Scholar 

  44. Hofstetter W, Correa AM, Bekele N, et al. Propos ed modification of nodal status in AJCC esophageal cancer staging system. Ann Thorac Surg 2007;84(2):365–373; discussion 374–5.

    Article  PubMed  Google Scholar 

  45. Wilson M, Rosato EL, Chojnacki KA, et al. Prognostic significance of lymph node metastases and ratio in esophageal cancer. J Surg Res 2008;146(1):11–15.

    Article  PubMed  Google Scholar 

  46. Shimada H, Okazumi S, Matsubara H, et al. Impact of the number and extent of positive lymph nodes in 200 patients with thoracic esophageal squamous cell carcinoma after three-field lymph node dissection. World J Surg 2006;30(8):1441–1449.

    Article  PubMed  Google Scholar 

  47. Hagen JA, DeMeester SR, Peters JH, et al. Curative r esection for esophageal adenocarcinoma: analysis of 100 en bloc esophagectomies. Ann Surg 2001;234(4):520–530; discussion 530–1.

    Article  PubMed  CAS  Google Scholar 

  48. Christie NA, Rice TW, DeCamp MM, et al. M1a/M1b esopha geal carcinoma: clinical relevance. J Thorac Cardiovasc Surg 1999;118(5):900–907.

    Article  PubMed  CAS  Google Scholar 

  49. Eloubeidi MA, Wallace MB, Hoffman BJ, et al. Predictors of survival for esophageal cancer patients with and without celiac axis lymphadenopathy: impact of staging endosonography. Ann Thorac Surg 2001;72(1):212–219; discussion 219–20.

    Article  PubMed  CAS  Google Scholar 

  50. Rice TW, Blackstone EH, Rybicki LA, et al. Refining esoph ageal cancer staging. J Thorac Cardiovasc Surg 2003;125(5):1103–1113.

    Article  PubMed  Google Scholar 

  51. Ohtsu A, Boku N, Muro K, et al. Definitive chemoradiothera py for T4 and/or M1 lymph node squamous cell carcinoma of the esophagus. J Clin Oncol 1999;17(9):2915–2921.

    PubMed  CAS  Google Scholar 

  52. Ishida K, Ando N, Yamamoto S, et al. Phase II study of cisp latin and 5-fluorouracil with concurrent radiotherapy in advanced squamous cell carcinoma of the esophagus: a Japan Esophageal Oncology Group (JEOG)/Japan Clinical Oncology Group trial (JCOG9516). Jpn J Clin Oncol 2004;34(10):615–619.

    Article  PubMed  Google Scholar 

  53. Forshaw MJ, Gossage JA, Chrystal K, et al. Neoadjuvant chemotherapy for locally advanced carcinoma of the lower oesophagus and oesophago-gastric junction. Eur J Surg Oncol 2006;32(10):1114–1118.

    PubMed  CAS  Google Scholar 

  54. Clark GW, Peters JH, Ireland AP, et al. Nodal metastasis and sites of recurrence after en bloc esophagectomy for adenocarcinoma. Ann Thorac Surg 1994;58(3):646–653; discussion 653–4.

    Article  PubMed  CAS  Google Scholar 

  55. Rizk N, Venkatraman E, Park B, et al. The prognostic importance of the number of involved lymph nodes in esophageal cancer: implications for revisions of the American Joint Committee on Cancer staging system. J Thorac Cardiovasc Surg 2006;132(6):1374–1381.

    Article  PubMed  Google Scholar 

  56. Rice TW, Rusch VW, Ishwaran H, et al. Cancer of the esophagus an d esophagogastric junction: data-driven staging for the seventh edition of the American Joint Committee on Cancer/International Union Against Cancer Cancer staging manuals. Cancer 2010;116(16):3763–3773.

    Article  PubMed  Google Scholar 

  57. Rice TW, Blackstone EH, Rusch VW. 7th edition of the AJCC cancer staging manual: esophagus and esophagogastric junction. Ann Surg Oncol 2010;17(7):1721–1724.

    Article  PubMed  Google Scholar 

  58. Nishimaki T, Tanaka O, Ando N, et al. Evaluation of the accuracy of preoperative staging in thoracic esophageal cancer. Ann Thorac Surg 1999;68(6):2059–2064.

    Article  PubMed  CAS  Google Scholar 

  59. Sohda M, Kato H, Suzuki S, et al. (18)F-FAMT-PET is useful for the diagnosis of lymph node metastasis in operable esophageal squamous cell carcinoma. Ann Surg Oncol 2010.

  60. Takizawa K, Matsuda T, Kozu T, et al. Lymph node staging in esophag eal squamous cell carcinoma: a comparative study of endoscopic ultrasonography versus computed tomography. J Gastroenterol Hepatol 2009;24(10):1687–1691.

    Article  PubMed  Google Scholar 

  61. Sandha GS, Severin D, Postema E, et al. Is positron emission tomogra phy useful in locoregional staging of esophageal cancer? Results of a multidisciplinary initiative comparing CT, positron emission tomography, and EUS. Gastrointest Endosc 2008;67(3):402–409.

    Article  PubMed  Google Scholar 

  62. Kajiyama Y, Iwanuma Y, Tomita N, et al. Size analysis of lymph node m etastasis in esophageal cancer: diameter distribution and assessment of accuracy of preoperative diagnosis. Esophagus 2006;3:189–195.

    Article  Google Scholar 

  63. Takeno A, Takiguchi S, Yamasaki M, et al. A suspected [18F]fluorodeoxy glucose positron emission tomography-negative metastatic lymph node successfully diagnosed by laparoscopic staging in esophageal cancer: report of two cases. Surg Today 2009;39(10):888–891.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Frontier Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8670, Japan

    Yasunori Akutsu & Hisahiro Matsubara

Authors
  1. Yasunori Akutsu
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Hisahiro Matsubara
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

About this article

Cite this article

Akutsu, Y., Matsubara, H. The significance of lymph node status as a prognostic factor for esophageal cancer. Surg Today 41, 1190–1195 (2011). https://doi.org/10.1007/s00595-011-4542-y

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00595-011-4542-y

Key words

Search

Navigation