Number of metastasis-positive lymph node stations is a simple and reliable prognostic factor following surgery in patients with esophageal cancer

Takeno, Shinsuke; Yamashita, Shinichi; Yamamoto, Satoshi; Takahashi, Yoshiaki; Moroga, Toshihiko; Kawahara, Katsunobu; Shiroshita, Toyoo; Yamana, Ippei; Maki, Kenji; Yamashita, Yuichi

doi:10.3892/etm.2012.705

Cited by 15 publications

(14 citation statements)

References 16 publications

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“…[6, 7] While not considered in the NET classification, the extent of LN involvement (i.e., the number of positive regional nodes) is an established predictor of survival in other cancers. [8–15] However, it remains unknown whether this potential prognostic factor provides additional information beyond tumor (T) and node (N) status in SI-NETs.…”

Section: Introductionmentioning

confidence: 99%

Prognostic Significance of Lymph Node Metastases in Small Intestinal Neuroendocrine Tumors

Kim

Warner

Ward³

et al. 2015

Neuroendocrinology

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Background/Aims: Current staging guidelines for small intestinal neuroendocrine tumors (SI-NETs) differentiate between the presence (N1) and absence (N0) of lymph node (LN) metastases. However, the prognostic significance of the extent of LN involvement remains unknown. In this study, we used data from a population-based cancer registry to examine whether involvement of a higher number of LNs is associated with worse survival. Methods: We used the Surveillance, Epidemiology, and End Results (SEER) database to identify patients with histologically confirmed, surgically resected SI-NETS diagnosed between 1988 and 2010. Patients were classified into three groups by the LN ratio (number of positive LNs/number of total LNs examined, LNR): ≤0.2, >0.2-0.5, and >0.5. We used the Kaplan-Meier method and Cox models to assess NET cancer-specific survival differences (up to 10 years from diagnosis) according to LNR status. Results: We identified 2,984 surgically resected patients with stage IIIb (N1, M0) SI-NETs with detailed LN data. More than half of the NETs were located in the ileum. A higher LNR was significantly associated with worse NET cancer-specific survival (p < 0.0001). Ten-year NET-specific survival was 85, 77, and 74% for patients in the ≤0.2, >0.2-0.5, and >0.5 LNR groups, respectively. In stratified analyses, higher LNR groups had worse survival only in early tumor (T1, T2) disease (p < 0.0001). Conclusions: The extent of LN involvement provides independent prognostic information on patients with LN-positive SI-NETs. This information may be used to identify patients at high risk of recurrence and inform decisions about the use of adjuvant therapy.

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Section: Introductionmentioning

confidence: 99%

Prognostic Significance of Lymph Node Metastases in Small Intestinal Neuroendocrine Tumors

Kim

Warner

Ward³

et al. 2015

Neuroendocrinology

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“…The distant metastasis rate has been reported to be 26% within 20 months after radical surgery. Hematoxylin and eosin staining is one of the most effective predictors of survival in esophageal cancer due to the number of lymph node metastases detected using this technique (18,19). …”

Section: Discussionmentioning

confidence: 99%

Esophageal cancer presenting as a brain metastasis: A case report

Spallone¹,

Izzo²

2013

Oncology Letters

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Carcinoma of unknown primary origin (CUP) is defined as the histological diagnosis of metastasis without the detection of a primary tumor. The incidence of CUP in all patients with a malignant disease has been reported to be between 3 and 15%. Esophageal cancer is the third most common type of cancer of the digestive tract and the seventh most common cause of cancer-related mortality worldwide. The overall incidence of the disease is highest in males >50 years old. Brain metastases have been reported in only 1.7–3.6% of all patients with different types of esophageal cancer. Brain metastasis as the presenting form of esophageal carcinoma is highly uncommon. The present study reports the case of a patient with an unknown primary tumor who presented with a cerebral metastasis, without extra-neurological symptoms. The CUP was subsequently diagnosed as an esophageal carcinoma.

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“…The highest number of the lymph node group containing metastasis is defined as N-category of the patient. Although many Japanese surgeons admit that number of metastatic nodes is the strongest prognostic factor (11,12), it is also true that the Japanese N-category and number of metastatic nodes have close relation (13). Because clinical diagnosis of lymph node metastasis still remains far from ideal (14-16), UICC cN-category which is defined by counting number of metastatic nodes in imaging examinations seems unreliable.…”

Section: N-categorymentioning

confidence: 99%

Comparison of two major staging systems of esophageal cancer—toward more practical common scale for tumor staging

Udagawa¹,

Ueno²

2018

Ann. Transl. Med.

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The latest 8th edition of TNM Classification of Malignant Tumours by Union for InternationalCancer Control (UICC) and 11th edition of Japanese Classification of Esophageal Cancer by Japan Esophageal Society (JES) are the two major classifications widely accepted as tools for clinical staging of esophageal cancer. Both systems consist of three main categories, i.e., T, N, and M, but large difference exists between the two. JES system has more detailed sub-classification of T1 tumors reflecting meticulous work by Japanese investigators on superficial esophageal cancer. N-category shows the largest difference. UICC defines the N-category according to only the number of the metastatic regional lymph nodes. The definition of regional nodes in UICC system is static and uniform, and supraclavicular nodes are definitely excluded. In JES system, regional nodes are subgrouped into five different patterns according to the main tumor location, and the supraclavicular nodes are always regional nodes for thoracic esophageal cancer. Japanese surgeons have described the evidence that regional nodes should be dynamically defined according to tumor location and supraclavicular nodes should be included in regional nodes. Compared to the simplified N-category, the staging matrix of UICC system is somewhat complicated. The clinical stage and pathological stage of UICC system are not identical and difference exists also between squamous cell carcinoma (SCC) and adenocarcinoma. It has another system of pathological prognostic grouping. We can imagine several reasons for the difference occurred between the two systems. One is the difference of major pathology. Another reason is the difference of basic concept of cancer treatment. The relative "dependence" on radical surgery in Japan has required the detailed definition of each lymph node station and the evaluation of "efficacy index" of each station. The strict and detailed definition of lymph node stations has been regarded as an obstacle to those who are not familiar with it. Some simplification can be done but maintaining dynamic definition of regional lymph nodes linked to tumor location. If UICC system can accept this concept, I think the two systems can be unified to realize more practical and useful staging system as an international common language.

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Number of metastasis-positive lymph node stations is a simple and reliable prognostic factor following surgery in patients with esophageal cancer

Cited by 15 publications

References 16 publications

Prognostic Significance of Lymph Node Metastases in Small Intestinal Neuroendocrine Tumors

Prognostic Significance of Lymph Node Metastases in Small Intestinal Neuroendocrine Tumors

Esophageal cancer presenting as a brain metastasis: A case report

Comparison of two major staging systems of esophageal cancer—toward more practical common scale for tumor staging

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