Clinical surgery–international
Location and clinical impact of solitary lymph node metastasis in patients with thoracic esophageal carcinoma

https://doi.org/10.1016/j.amjsurg.2006.01.023Get rights and content

Abstract

Background

The location and clinical impact of solitary lymph node metastasis from thoracic esophageal carcinoma have not been evaluated sufficiently.

Methods

A consecutive series of 91 patients with a solitary positive lymph node who underwent curative surgery for thoracic esophageal carcinoma was investigated. The prognostic impact was evaluated by univariate analysis and multivariate analysis using Cox’s proportional hazards model.

Results

A total of 52 (57%) of the 91 patients showed a solitary positive node beyond the thorax. While 29% of the patients with an upper thoracic tumor showed a cervical node, 13% of the patients with a middle tumor and none of the patients with a lower tumor showed a cervical node. Tumor depth and venous invasion were found to be independent risk factors for poor survival.

Conclusions

The solitary positive lymph nodes were broadly distributed depending on the tumor location and tumor depth. Tumor depth and venous invasion were risk factors for poor survival in these patients.

Section snippets

Patients with a solitary positive node

Between 1970 and 2002, 652 patients with thoracic esophageal cancer underwent R0 esophagectomy with lymphadenectomy without any neoadjuvant treatment. A total of 237 (36%) patients showed no lymph node metastases and 91 (14%) patients showed a solitary lymph node metastasis. The patients with a solitary positive node consisted of 80 males (88%) and 11 females (12%), with a median age of 64 years (range 27 to 84 years).

Surgery and pathological examinations

All patients with untreated primary tumors underwent esophagectomy via

Comparison of clinicopathologic features between node-negative patients and solitary node-positive patients

Although overall survival did not show a statistically significant difference between the 2 groups, cause-specific survival revealed that patients with a solitary positive node showed a significantly worse survival than that of node-negative patients (Fig. 1).

Distribution of solitary positive nodes according to tumor location

The distribution of the location of solitary positive nodes was 10% in the cervix, 24% in the upper thorax, 19% in the lower thorax and 47% in the abdomen. A total of 39 (43%) of 91 patients had a solitary positive node in the thorax and

Comments

In the present study, we investigated the distribution of solitary positive lymph node metastasis in patients with thoracic esophageal carcinoma. We observed that 43% of positive nodes were present in an intra-thorax field. However, 57% of the patients showed extra-thorax metastasis, including 7 patients who showed a solitary node to a site opposite tumor location. Furthermore, for tumors in the upper and middle thorax, the initial nodes were distributed to the cervix, thorax, and abdomen.

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Supported in part by the 21st Century Center of Excellence Project and a Grant-in-Aid from the Ministry of Education, Science and Culture of Japan.

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