| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
|
|
|
|||||||
|
|||||||||
Ann Thorac Surg 2004;78:1161-1169
© 2004 The Society of Thoracic Surgeons
a Department of SurgeryKeck School of Medicine, University of Southern California, Los Angeles, California, USA,
b Division of Thoracic/Foregut Surgery and Pathology, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
Accepted for publication April 12, 2004.
* Address reprint requests to Dr Hagen, Department of Clinical Surgery, University of Southern California, HCC 514, 1510 San Pablo St, Ste 514, Los Angeles, CA, USA 90033
hagen{at}usc.edu
Presented at the Fortieth Annual Meeting of The Society of Thoracic Surgeons, San Antonio, TX, Jan 26–28, 2004.
BACKGROUND: The number or ratio of lymph node metastases detected by hematoxylin & eosin (H&E) staining is the most important predictor of survival in esophageal cancer. The survival effect of lymph node metastases detected on immunohistochemistry (IHC) is controversial. My colleagues and I hypothesized that the extent of nodal disease determined by both H&E and IHC examination would more accurately predict survival than either technique alone.
METHODS: The study population consisted of 37 patients who underwent en bloc esophagectomy as primary therapy for esophageal adenocarcinoma 5 or more years ago. All had mediastinal and upper abdominal lymphadenectomy. No patient received neoadjuvant or adjuvant therapy. Tissue blocks were sectioned for H&E staining to confirm the initial histology, and a second slide was stained with monoclonal antibodies AE1 and CAM 5.2, which are directed at a number of cytokeratin antigens. The slides were reviewed by an investigator blinded to clinical outcome. The effect of IHC staining on prognosis was assessed by comparing 5-year survival based on H&E and IHC findings.
RESULTS: A total of 1,970 nodes were examined in the 37 patients. Routine H&E staining detected metastases in 29 patients (78%); the remaining 8 with N0 disease all survived at least 5 years after operation (median not reached). In the 29 patients with N1 disease, survival was 41% at 5 years. In 20 of the 29 N1 patients, metastases were detected by H&E in less than 10% of the nodes removed; 55% of the patients survived 5 years, and 39% survived 8 years. Nine of the 29 patients had metastases detected in more than 10% of the nodes removed, and all died at a median of 17 months. IHC staining was performed on the nodes from the 8 N0 patients and the 20 patients with less than 10% nodal involvement (a total of 28 patients). Additional nodal metastases, not identified on H&E examination, were found in 51 nodes from 17 patients (60.7%). Of the 8 patients who were node negative on H&E examination, 3 had metastases detected by IHC, and all survived 5 years or more free of disease. Of the 20 patients with less than 10% nodal metastases on H&E, 14 (70%) had additional metastases detected by IHC (median, 2 nodes per patient). When combined with the results of H&E staining, the node ratio remained less than 10% in 13 patients and exceeded 10% in 7. Survival in patients whose ratio remained less than 10% was significantly better than in those whose ratio exceeded 10% (actual 5-year survival, 77% vs 14%; 
2 = 4.662; p = 0.03).
CONCLUSIONS: IHC staining techniques can identify nodal metastases missed by routine H&E examination in a large number of patients. The combination of H&E and IHC examination is useful in patients with less than 10% nodal involvement by H&E examination in that IHC detection of micrometastases allows classification into low-risk (> 75% survival) and high-risk (< 15% survival) groups. IHC-detected micrometastases are not of prognostic importance in N0 patients or those with greater than 10% nodal metastases on H&E.
This article has been cited by other articles:
|
|
 |
|
  J. E. Gervasoni Jr., S. Sbayi, and B. Cady Role of lymphadenectomy in surgical treatment of solid tumors: an update on the clinical data. Ann. Surg. Oncol., September 1, 2007; 14(9): 2443 - 2462. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 D. K. Dhar, S. Hattori, Y. Tonomoto, T. Shimoda, H. Kato, M. Tachibana, K. Matsuura, Y. Mitsumoto, A. G. Little, and N. Nagasue Appraisal of a Revised Lymph Node Classification System for Esophageal Squamous Cell Cancer Ann. Thorac. Surg., April 1, 2007; 83(4): 1265 - 1272. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 S. M. Lagarde, F. J.W. ten Kate, J. B. Reitsma, O. R.C. Busch, and J. J. B. van Lanschot Prognostic Factors in Adenocarcinoma of the Esophagus or Gastroesophageal Junction J. Clin. Oncol., September 10, 2006; 24(26): 4347 - 4355. [Abstract] [Full Text] [PDF]
|
|
| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
| ANN THORAC SURG | ASIAN CARDIOVASC THORAC ANN | EUR J CARDIOTHORAC SURG |
| J THORAC CARDIOVASC SURG | ICVTS | ALL CTSNet JOURNALS |
