Prognostic Impact of Lymph Node Localization in Node-Positive Esophageal Cancer

Abstract

Background: Recurrent disease remains a major problem for esophageal cancer. This study was designed to evaluate the impact of localization of lymph node metastasis for tumor recurrence following curative esophageal resection. Methods: 273 patients undergoing esophagectomy for esophageal cancer between 2005 and 2014 at the Department of General, Visceral and Transplant Surgery, University Hospital of Münster were included. Tumor characteristics, treatment details, postoperative course and patients' outcome, including time point and localization of recurrent disease, were analyzed retrospectively. The median follow-up was 46.3 months. Results: Median overall and disease-free survivals were 22.7 and 13 months, respectively. Tumor characteristics including presence and number of lymph node metastasis, and localization of lymph node metastases, paraesophageal, perigastric and intra-abdominal, had significant impact on both tumor recurrence (p<0.001, p=0.003, and p=0.001, respectively) and disease-free survival (p<0.001, p=0.001, and p<0.001, respectively). Univariate and multivariate analysis confirmed tumor stage, lymph node metastasis, G-, L- and V-category, and neoadjuvant treatment as independent predictors of tumor recurrence. Conclusion: The tumor stage and response to neoadjuvant treatment remain the most important prognostic factors. In addition, localization and the number of resected lymph node metastasis can provide important additional information.