Clinical implications of quantitative pathological and immunohistochemical markers for lymph node metastasis in esophageal cancer patients based on preoperative treatment status

Abstract

Whether the prognostic abilities of markers of lymphatic spread are affected by preoperative chemotherapy or chemoradiotherapy for esophageal cancer has not been clarified. The purpose of this study was to determine significant prognostic predictors related to lymphatic spread in potentially curable esophageal cancer according to preoperative treatment status. The prognostic significance of quantitative pathological and immunohistochemical markers of lymphatic spread was determined in 80 esophageal cancer patients undergoing R0 resection with or without preoperative treatment. Univariate analysis revealed that the presence or absence of immunohistochemical nodal micrometastasis (iNM), number of pathological nodal metastases (pNM) and iNM, and the ratios of pNM and iNM to removed nodes were significant prognostic predictors in patients undergoing esophagectomy without preoperative treatment. In contrast, only the presence or absence of pNM, number of pNM, and pNM ratio were significant prognostic indicators in patients undergoing esophagectomy after preoperative treatment. Multivariate analysis revealed that the number of iNM, a novel prognostic indicator found in the present study, was the only independent prognostic predictor in the former patients, whereas the number of pNM was the only independent prognostic predictor in the latter patients. In esophageal cancer, the prognostic values of factors related to lymphatic spread depend on the patient’s preoperative treatment status. Two or more pNM indicated poor prognosis after esophagectomy in patients undergoing preoperative treatment for advanced disease. However, 2 or more iNM indicated poor prognosis after esophagectomy in patients undergoing upfront esophagectomy for less advanced disease.