| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
|
|
|
|||||||
|
|||||||||
Ann Thorac Surg 2007;84:365-375
© 2007 The Society of Thoracic Surgeons
a Department of Thoracic and Cardiovascular Surgery, University of Texas MD Anderson Cancer Center, Houston, Texas
b Department of Gastrointestinal Medical Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas
c Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas
d Department of Pathology, University of Texas MD Anderson Cancer Center, Houston, Texas
e Department of Biostatistics, University of Texas MD Anderson Cancer Center, Houston, Texas
Accepted for publication January 29, 2007.
* Address correspondence to Dr Hofstetter, University of Texas MD Anderson Cancer Center, Department of Thoracic and Cardiovascular Surgery, Esophageal Cancer Program, 1515 Holcombe Blvd, Box 445, Houston, TX 77030 (Email: whofstetter{at}mdanderson.org).
Presented at the Fifty-third Annual Meeting of the Southern Thoracic Surgical Association, Tucson, AZ, Nov 8–11, 2006.
Background: The current American Joint Committee on Cancer (AJCC) esophageal cancer staging for nodal status is difficult to interpret and is based solely on lymph node location relative to the primary tumor’s esophageal location. Recent reports suggest that the number of lymph nodes involved is also an important factor. We reviewed our esophageal experience to propose an improved nodal staging system.
Methods: In all, 1,027 patients with resected esophageal cancer from 1970 to 2005 were reviewed. Lymph nodes stations were assigned according to AJCC criteria. Overall survival was assessed by Kaplan-Meier analysis. The impact of location, number of involved lymph nodes, and use of preoperative chemotherapy or radiation therapy, or both, was assessed.
Results: Nonregional nodal involvement (n = 17) was associated with decreased survival compared with regional (n = 441) or celiac nodal (n = 73) involvement (3-year: 0% versus 24% and 23%; p < 0.001). The number of involved lymph nodes was strongly associated with survival (3-year: 0 nodes = 63%, 1 to 3 nodes = 31%, more than 3 nodes = 13%; p < 0.001), and multivariable Cox proportional-hazards analysis suggested that the location and number of involved lymph nodes were independent predictors of survival (p < 0.001). We propose a modified nodal staging system that designates celiac nodes as regional and includes number of involved nodes: pN0, no nodes (3 years = 63%, n = 496); pN1-regional, 1 to 3 nodes (3 years = 32%, n = 292); pN2-regional, more than 3 nodes (3 years = 14%, n = 222); pN3-nonregional node (3 years = 0%, n = 17 [p < 0.0001]). This modified nodal staging system better predicts survival than the current AJCC nodal staging system in which survival for pN1 (3 years = 24%) and pM1a (3 years = 23%) do not differ (p = 0.67). The use of induction before surgical resection did not alter the predictive effect of the new nodal staging system.
Conclusions: Modification of the AJCC nodal classification system to incorporate the number of involved lymph nodes with regional and nonregional node location simplifies and better predicts long-term survival than does the current AJCC nodal system.
This article has been cited by other articles:
|
|
 |
|
  W. D. Bolton, W. L. Hofstetter, A. M. Francis, A. M. Correa, J. A. Ajani, M. S. Bhutani, J. Erasmus, R. Komaki, D. M. Maru, R. J. Mehran, et al. Impact of tumor length on long-term survival of pT1 esophageal adenocarcinoma J. Thorac. Cardiovasc. Surg., October 1, 2009; 138(4): 831 - 836. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
E. S. Kassis, A. A. Vaporciyan, S. G. Swisher, A. M. Correa, B. N. Bekele, J. J. Erasmus, W. L. Hofstetter, R. Komaki, R. J. Mehran, C. A. Moran, et al. Application of the revised lung cancer staging system (IASLC Staging Project) to a cancer center population J. Thorac. Cardiovasc. Surg., August 1, 2009; 138(2): 412 - 418. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 P. C. Lee, J. L. Port, S. Paul, B. M. Stiles, and N. K. Altorki Predictors of long-term survival after resection of esophageal carcinoma with nonregional nodal metastases. Ann. Thorac. Surg., July 1, 2009; 88(1): 186 - 193. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. Deeter, R. Dorer, M. K. Kuppusamy, R. P. Koehler, and D. E. Low Assessment of Criteria and Clinical Significance of Circumferential Resection Margins in Esophageal Cancer Arch Surg, July 1, 2009; 144(7): 618 - 624. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
W.-H. Hsu, P.-K. Hsu, S.-J. Wang, K.-H. Lin, C.-S. Huang, C.-C. Hsieh, and Y.-C. Wu Positron emission tomography-computed tomography in predicting locoregional invasion in esophageal squamous cell carcinoma. Ann. Thorac. Surg., May 1, 2009; 87(5): 1564 - 1568. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
C.-S. Lin, S.-C. Chang, Y.-H. Wei, T.-Y. Chou, Y.-C. Wu, H.-C. Lin, L.-S. Wang, and W.-H. Hsu Prognostic Variables in Thoracic Esophageal Squamous Cell Carcinoma Ann. Thorac. Surg., April 1, 2009; 87(4): 1056 - 1065. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. M. Donahue, F. C. Nichols, Z. Li, D. A. Schomas, M. S. Allen, S. D. Cassivi, A. Jatoi, R. C. Miller, D. A. Wigle, K. R. Shen, et al. Complete pathologic response after neoadjuvant chemoradiotherapy for esophageal cancer is associated with enhanced survival. Ann. Thorac. Surg., February 1, 2009; 87(2): 392 - 398. [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 |
