Prognostic significance of lymph node metastases and ratio in esophageal cancer

J Surg Res. 2008 May 1;146(1):11-5. doi: 10.1016/j.jss.2007.07.028. Epub 2007 Aug 28.


Background: The incidence of carcinoma of the distal esophagus and GE junction is rapidly increasing. A large single-center experience was reviewed to determine the impact of lymph node positivity and ratio on survival.

Methods: All patients undergoing esophagogastrectomy at Thomas Jefferson University Hospital between January 1994 and December 2004 were reviewed. Univariate and multivariate analyses were performed using log-rank and Cox proportional hazard models, and survival curves were estimated using the Kaplan-Meier method.

Results: Of 173 patients with invasive cancer, 123 (71%) underwent preoperative chemoradiation therapy. The largest number of patients (45%) had adenocarcinoma of the GE junction; 29% of patients had esophageal adenocarcinoma while 14% had squamous cell cancer of the esophagus. Perioperative mortality was 5.7%. Median overall survival of the entire group was 22 months and 5-year overall survival was 27%. The most significant prognostic factor for overall survival was the presence of positive LN (P = 0.01). Additionally, patients with zero involved LN had a 5-year survival of 34%, while patients with 1 to 3 positive LN and >3 positive LN had 5-year survival of 27% and 9%, respectively (P = 0.01). Finally, an increasing ratio of positive to examined LN was linearly associated with a worsening 5-year survival, (P = 0.153).

Conclusions: Increasing number of positive LN in patients with esophageal cancer and increasing ratio of metastatic to examined LN portend a poor prognosis. These factors should play an important role in determining which patients receive adjuvant therapy.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Adenocarcinoma / diagnosis*
  • Adenocarcinoma / pathology*
  • Adult
  • Aged
  • Aged, 80 and over
  • Esophageal Neoplasms / diagnosis*
  • Esophageal Neoplasms / pathology*
  • Female
  • Humans
  • Kaplan-Meier Estimate
  • Lymph Nodes / pathology*
  • Lymphatic Metastasis / pathology*
  • Male
  • Middle Aged
  • Multivariate Analysis
  • Neoplasm Staging
  • Prognosis
  • Proportional Hazards Models
  • Retrospective Studies