Prognostic value of occult lymph node metastases in patients with completely resected esophageal squamous cell carcinoma

Abstract

To investigate the prognostic value of occult lymph node metastases (OLNMs) in patients with pathologically lymph node negative (pN0) esophageal squamous cell carcinoma (ESCC). OLNMs were detected in 516 pN0 ESCC patients by immunohistochemical staining. The correlation between the clinicopathological features and OLNM, and the prognostic value of OLNM was explored. Eighty-eight patients (17.1%) had OLNMs, including 37 patients with isolated tumor cells (ITCs), 49 patients with micrometastases, and 2 patients with macrometastases (> 2 mm). The OLNM-positive group had poorer differentiation and a more advanced pT category. The 5-year overall survival and disease-free survival for patients with OLNMs were significantly worse than those of IHC-negative patients (P < 0.001), but similar to those of the pN1 patients (P > 0.05). The multivariate analysis showed that OLNM was an independent prognostic factor. In subgroup analyses, the IHC-negative patients had significant survival advantages compared with the ITC group and the micrometastasis group, whereas the survival for the ITC group was similar to that of the micrometastasis group. IHC staining in pN0 ESCC patients might help to identify patients at high risk of death after resection, and ITCs in the lymph nodes appear to have a prognostic value equal to that of micrometastases.

Prognostic value of lymph node micrometastasis in esophageal cancer: A systematic review and meta-analysis

“…Subsequently, 45 full-text manuscripts were assessed for eligibility, from which 29 did not meet the inclusion criteria and were excluded. Accordingly, only 16 studies including 1,652 patients were included ( 5 – 7 , 17 – 21 , 25 – 32 ) ( Figure 1 ). The study characteristics and baseline demographics are shown ( Table 1 ).…”

“…A total of 944 patients were identified in seven studies ( 5 , 7 , 19 , 25 , 26 , 28 , 30 ). The RFS was significantly increased with LNM negativity compared with LNM positivity in esophageal cancer patients (HR 3.39; 95% CI, 1.87–6.16; P < 0.001; I 2 = 50.18%, P = 0.060; Figure 3 ; certainty of evidence, moderate).…”

“…However, immunohistochemical (IHC) staining for cytokeratin can highlight small tumor cells, making them more easily detectable. A previous study ( 5 ) has reported that patients with LNM had significantly lower disease-free survival rates than those with negative lymph node metastasis in esophageal cancer. Another study ( 6 ) has reported that patients with LNM have a higher local recurrence rate than those without LNM.…”

“…We assessed the effect of the prognostic value of LNM in esophageal cancer on three outcomes: OS, RFS, and recurrence. In five of the included studies (5,8,(17)(18)(19), disease-free survival was regarded as RFS because they have the same definition.…”

Nonregional Lymph Nodes as the Only Metastatic Site in Stage IV Esophageal Cancer

“…Sensitivity analyses incorporating N stage and grade in the multivariable Cox models revealed similar associations between metastatic pattern and survival (data available on request). The study did not include molecular profiling, which has some correlation with the outcome, 26 , 27 , 28 , 29 , 30 but it is not currently a component of stage classification. It is possible that the patients with stage IV-nodal disease had molecular characteristics that were more favorable.…”