S. Cresse1, O. Picado1, B. Azab1, D. Franceschi1, A. Livingstone1, D. Yakoub1 1University Of Miami Leonard M. Miller School Of Medicine,Division Of Surgical Oncology, DeWitt Daughtry Family Department Of Surgery,Miami, FL, USA
Introduction:
Esophageal adenocarcinoma presents with high incidence of lymph node metastases even in early disease. We aimed to evaluate the impact of regional lymph node involvement on survival of locally advanced stage II and III esophageal adenocarcinoma.
Methods:
The National Cancer Database (2004-2013) was used to identify patients with clinical stage II and III esophageal adenocarcinoma who had esophagectomy and regional lymphadenectomy. Patients with ≥15 lymph nodes sampled (as recommended by NCCN) were analyzed. The proportion of positive lymph nodes for metastatic disease was identified. The association between pathological N stage, positive/examined lymph node ratio and hazard of death was assessed using Kaplan-Meier method and Cox regression model.
Results:
We identified 3123 with clinical stage II and III esophageal adenocarcinoma. Mean age was 61 years. M/F ratio was 9:1. Perioperative chemotherapy was administered to 2808 (90%) patients with or without radiation. Patients were distributed as follows, clinical T1, T2, T3 and T4 in 4%, 22%, 71%, and 1%, respectively. Clinical N0, N1, N2, and N3 were present in 33% 56%, 8%, and 1%, respectively. Upon histopathological examination of surgical specimens, 9% of cN0/cN1 were pathologically upstaged to pN1, pN2 and pN3, while 60% of cN2/cN3 were downstaged to pN0 and pN1. Median follow-up time was 39 months. Increasing pathological T stage was associated with worse overall survival. Analysis of pathological N stage showed a median overall survival of 60, 26, 24, and 20 months for N0, N1, N2 and N3, respectively. N0 had significantly better survival than N1-3 (p<0.001). Among N1, 2 and 3 there was no difference in survival. However, analysis of positive/examined lymph node ratio showed that overall survival significantly dropped when the positive/examined lymph node ratio was above 0.25 (18 months vs. 31 months, p<0.05).
Conclusion:
Lymph node involvement is the major determinant of poor survival in stage II and III esophageal adenocarcinoma patients. Positive/examined lymph node ratio greater than 0.25 is associated with significantly worse survival.
