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Evaluation of the Nodal Status in the 7th Edition of the UICC-TNM Classification for Esophageal Squamous Cell Carcinoma: Proposed Modifications for Improved Survival Stratification

Impact of Lymph Node Metastases on Overall Survival after Esophagectomy

  • Thoracic Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

The 7th edition of the Union for International Cancer Control-TNM (UICC-TNM) classification for esophageal carcinoma made considerable modifications to the definition of N-staging by the number of involved lymph nodes and the regional node boundary. There were few validations of the regional boundary. We evaluated the nodal status of this classification for esophageal squamous cell carcinoma (ESCC).

Methods

There were 665 patients reviewed who had ESCC and underwent esophagectomy between 1997 and 2012. We evaluated the impact of the location of lymph node metastasis on overall survival.

Results

There were 414 patients (61.7 %) who had lymph node metastases. The overall 5-year survival rate was 54.7 %. There were no significant differences in survival among N2, N3, and M1 patients. Cox regression analysis revealed that common hepatic or splenic node involvements (P = 0.001), pT stage (P = 0.0002), and pN stage (P < 0.0001) were independent predictors of survival, but supraclavicular node involvement (P = 0.29) was not. We propose a modified nodal status that designates supraclavicular node as regional: m-N0 (5-year survival = 79 %; n = 251); m-N1 (5-year = 56 %; n = 212); m-N2 (5-year = 30 %; n = 114); m-N3 (5-year = 18 %; n = 52); m-M1 (5-year = 6.2 %; n = 36). This modified nodal staging predicts survival better than the current staging system.

Conclusions

The modification of supraclavicular lymph node from nonregional to regional in the 7th UICC classification of ESCC may allow for better stratification of overall survival.

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References

  1. Jemal A, Siegel R, Ward E, Hao Y, Xu J, Thun MJ. Cancer statistics, 2009. CA Cancer J Clin. 2009;59:225–49.

    Article  PubMed  Google Scholar 

  2. Sobin LH, Gospodarowicz MK, Wittekind C. TNM classification of malignant tumors. 7th ed. Oxford: Wiley-Blackwell; 2010.

    Google Scholar 

  3. Rizk N, Venkatraman E, Park B, Flores R, Bains MS, Rusch V. The prognostic importance of the number of involved lymph nodes in esophageal cancer: implications for revisions of the American Joint Committee on Cancer staging system. J Thorac Cardiovasc Surg. 2006;132:1374–81.

    Article  PubMed  Google Scholar 

  4. Altorki NK, Lee PC, Liss Y, et al. Multifocal neoplasia and nodal metastases in T1 esophageal carcinoma: implications for endoscopic treatment. Ann Surg. 2008;247:434–9.

    Article  PubMed  Google Scholar 

  5. Peyre CG, Hagen JA, DeMeester SR, et al. Predicting systemic disease in patients with esophageal cancer after esophagectomy: a multinational study on the significance of the number of involved lymph nodes. Ann Surg. 2008;248:979–85.

    Article  PubMed  Google Scholar 

  6. Peyre CG, Hagen JA, DeMeester SR, et al. The number of lymph nodes removed predicts survival in esophageal cancer: an international study on the impact of extent of surgical resection. Ann Surg. 2008;248:549–56.

    Article  PubMed  Google Scholar 

  7. Mariette C, Piessen G, Briez N, Triboulet JP. The number of metastatic lymph nodes and the ratio between metastatic and examined lymph nodes are independent prognostic factors in esophageal cancer regardless of neoadjuvant chemoradiation or lymphadenectomy extent. Ann Surg. 2008;247:365–71.

    Article  PubMed  Google Scholar 

  8. Hofstetter W, Correa AM, Bekele N, et al. Proposed modification of nodal status in AJCC esophageal cancer staging system. Ann Thorac Surg. 2007;84:365–73.

    Article  PubMed  Google Scholar 

  9. Yamasaki M, Miyata H, Fujiwara Y, et al. p53 genotype predicts response to chemotherapy in patients with squamous cell carcinoma of the esophagus. Ann Surg Oncol. 2010;17:634–42.

    Article  PubMed  Google Scholar 

  10. Yamasaki M, Miyata H, Tanaka K, et al. Multicenter phase I/II study of docetaxel, cisplatin and fluorouracil combination chemotherapy in patients with advanced or recurrent squamous cell carcinoma of the esophagus. Oncology. 2011; 80:307–13.

    Article  CAS  PubMed  Google Scholar 

  11. Makino T, Yamasaki M, Miyata H, et al. p53 Mutation status predicts pathological response to chemoradiotherapy in locally advanced esophageal cancer. Ann Surg Oncol. 2010;17:804–11.

    Article  PubMed  Google Scholar 

  12. Shiozaki H, Yano M, Tsujinaka T, et al. Lymph node metastasis along the recurrent nerve chain is an indication for cervical lymph node dissection in thoracic esophageal cancer. Dis Esophagus. 2001;14:191–6.

    Article  CAS  PubMed  Google Scholar 

  13. Yoshioka S, Fujiwara Y, Sugita Y, et al. Real-time rapid reverse transcriptase-polymerase chain reaction for intraoperative diagnosis of lymph node micrometastasis: clinical application for cervical lymph node dissection in esophageal cancers. Surgery. 2002;132:34–40.

    Article  PubMed  Google Scholar 

  14. Miyata H, Yano M, Doki Y, et al. A prospective trial for avoiding cervical lymph node dissection for thoracic esophageal cancers, based on intra-operative genetic diagnosis of micrometastasis in recurrent laryngeal nerve chain nodes. J Surg Oncol. 2006;93:477–84.

    Article  PubMed  Google Scholar 

  15. Talsma K, van Hagen P, Grotenhuis BA, Steyerberg EW, Tilanus HW, van Lanschot JJ, Wijnhoven BP. Comparison of the 6th and 7th editions of the UICC-AJCC TNM classification for esophageal cancer. Ann Surg Oncol. 2012;19:2142–8.

    Article  PubMed Central  PubMed  Google Scholar 

  16. Reeh M, Nentwich MF, von Loga K, et al. An attempt at validation of the seventh edition of the classification by the International Union Against Cancer for esophageal carcinoma. Ann Thorac Surg. 2012; 93:890–6.

    Article  PubMed  Google Scholar 

  17. Hsu PK, Wu YC, Chou TY, Huang CS, Hsu WH. Comparison of the 6th and 7th editions of the American Joint Committee on Cancer tumor-node-metastasis staging system in patients with resected esophageal carcinoma. Ann Thorac Surg. 2010;89:1024–31.

    Article  PubMed  Google Scholar 

  18. Xu Q-R, Zhuge X-P, Zhang H-L, Ping Y-M, Chen L-Q. The N-classification for esophageal cancer staging: should it be based on number, distance, or extent of the lymph node metastasis? World J Surg. 2011; 35:1303–10.

    Article  PubMed  Google Scholar 

  19. Rizk NP, Ishwaran H, Rice TW, et al. Optimum lymphadenectomy for esophageal cancer. Ann Surg. 2010;251:46–50.

    Article  PubMed  Google Scholar 

  20. Schomas DA, Quevedo JF, Donahue JM, Nichols FC 3rd, Romero Y, Miller RC. The prognostic importance of pathologically involved celiac node metastases in node-positive patients with carcinoma of the distal esophagus or gastroesophageal junction: a surgical series from the Mayo Clinic. Dis Esophagus. 2010;23:232–9.

    Article  PubMed  Google Scholar 

  21. Shim YM, Choi Y S, Kim K. Prognosis after surgical resection of M1a/M1b esophageal squamous cell carcinoma. J Korean Med Sci. 2005; 20:229–31.

    Article  PubMed Central  PubMed  Google Scholar 

  22. Rice TW, Blackstone EH, Rybicki LA et al. Refining esophageal cancer staging. J Thorac Cardiovasc Surg. 2003; 125:1103–13.

    Article  PubMed  Google Scholar 

  23. Christie NA, Rice TW, DeCamp MM, et al. M1a/M1b esophageal carcinoma: clinical relevance. J Thorac Cardiovasc Surg. 1999;118:900–7.

    Article  CAS  PubMed  Google Scholar 

  24. Trovo M, Bradley J, El Naqa I, Foster E, Meyers B, Govindan R, Patterson A. Esophageal carcinoma with celiac nodal metastases; curative or palliative? J Thorac Oncol. 2008;3:751–5.

    Article  PubMed  Google Scholar 

  25. Lerut T, Nafteux P, Moons J, et al. Three-field lymphadenectomy for carcinoma of the esophagus and gastroesophageal junction in 174 R0 resections: impact on staging, disease-free survival, and outcome: a plea for adaptation of TNM classification in upper-half esophageal carcinoma. Ann Surg. 2004;240:962–72.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  26. Igaki H, Kato H, Tachimori Y, Sato H, Daiko H, Nakanishi Y. Prognostic evaluation for squamous cell carcinomas of the lower thoracic esophagus treated with three-field lymph node dissection. Eur J Cardiothorac Surg. 2001;19:887–93.

    Article  CAS  PubMed  Google Scholar 

  27. Igaki H, Kato H, Tachimori Y, Nakanishi Y. Prognostic evaluation of patients with clinical T1 and T2 squamous cell carcinomas of the thoracic esophagus after 3-field lymph node dissection. Surgery. 2003;133:368–74.

    Article  PubMed  Google Scholar 

  28. Igaki H, Tachimori Y, Kato H. Improved survival for patients with upper and/or middle mediastinal lymph node metastasis of squamous cell carcinoma of the lower thoracic esophagus treated with 3-field dissection. Ann Surg. 2004;239:483–90.

    Article  PubMed Central  PubMed  Google Scholar 

  29. Shim YM, Kim HK, Kim K. Comparison of survival and recurrence pattern between two-field and three-field lymph node dissections for upper thoracic esophageal squamous cell carcinoma. J Thorac Oncol. 2010;5:707–12.

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Suita, Osaka, Japan

    Makoto Yamasaki MD, Hiroshi Miyata MD, Yasuhiro Miyazaki MD, Tsuyoshi Takahashi MD, Yukinori Kurokawa MD, Kiyokazu Nakajima MD, Shuji Takiguchi MD, Masaki Mori MD & Yuichiro Doki MD

Authors
  1. Makoto Yamasaki MD
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  2. Hiroshi Miyata MD
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  3. Yasuhiro Miyazaki MD
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  4. Tsuyoshi Takahashi MD
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  5. Yukinori Kurokawa MD
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  6. Kiyokazu Nakajima MD
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  7. Shuji Takiguchi MD
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  8. Masaki Mori MD
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  9. Yuichiro Doki MD
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Corresponding author

Correspondence to Makoto Yamasaki MD.

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Yamasaki, M., Miyata, H., Miyazaki, Y. et al. Evaluation of the Nodal Status in the 7th Edition of the UICC-TNM Classification for Esophageal Squamous Cell Carcinoma: Proposed Modifications for Improved Survival Stratification. Ann Surg Oncol 21, 2850–2856 (2014). https://doi.org/10.1245/s10434-014-3696-4

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  • DOI: https://doi.org/10.1245/s10434-014-3696-4

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