Factor In Esophageal Cancer Research Articles

Survival Rate and Prognostic Factors of Esophageal Cancer in East Azerbaijan Province, North-west of Iran

Esophageal cancer in Iran is the sixth most common cancer and is particularly important in east Azerbaijan. The aim of this study was to calculate survival rates and define prognostic factors in esophageal cancer patients. In this study, all patients with esophageal cancer registered in the Radiation Therapy Center, during March 2006 to March 2011, were analyzed and followed up for vital status. Data were analyzed using the Kaplan-Meier method and the Cox proportional hazard models. Out of 532 patients, survival information was available for 460, including 205 (44/5%) females and 255 (55/4%) males. The mean age was 65.8±12.2, ranging from 29 to 90 years at the time of diagnosis. 1- , 3- and 5-year survival rates after diagnosis were 55%, 18% and 12%, respectively, with a median survival time of 13.2 ± .7 (CI 95%=11.8-14.6) months. In the univariate analysis, age (P=0/001), education (P=0/001), smoking status (P= 0/001), surgery (P=0/001), tumor differentiation (P=0/003) and tumor stage (P=0/001) were significant prognostic factors. Tumor morphology, sex, place of residence, tumor histology and tumor location did not show any significant effects on the survival rate. In multivariate analysis, age (P=0/003), smoking (P=0/01) and tumor stage (P=0/001) were significant independent predictors of survival. In summary, prognosis of esophageal cancer in North West of Iran is poor. Therefore, reduction in exposure to risk factors and early detection should be emphasized to improve survival.

Prognostic significance of anti-p53 and anti-KRas circulating antibodies in esophageal cancer patients treated with chemoradiotherapy

BackgroundP53 mutations are an adverse prognostic factor in esophageal cancer. P53 and KRas mutations are involved in chemo-radioresistance. Circulating anti-p53 or anti-KRas antibodies are associated with gene mutations. We studied whether anti-p53 or anti-KRas auto-antibodies were prognostic factors for response to chemoradiotherapy (CRT) or survival in esophageal carcinoma.MethodsSerum p53 and KRas antibodies (abs) were measured using an ELISA method in 97 consecutive patients treated at Saint Louis University Hospital between 1999 and 2002 with CRT for esophageal carcinoma (squamous cell carcinoma (SCCE) 57 patients, adenocarcinoma (ACE) 27 patients). Patient and tumor characteristics, response to treatment and the follow-up status of 84 patients were retrospectively collected. The association between antibodies and patient characteristics was studied. Univariate and multivariate survival analyses were conducted.ResultsTwenty-four patients (28%) had anti-p53 abs. Abs were found predominantly in SCCE (p = 0.003). Anti-p53 abs were associated with a shorter overall survival in the univariate analysis (HR 1.8 [1.03-2.9], p = 0.04). In the multivariate analysis, independent prognostic factors for overall and progression-free survival were an objective response to CRT, the CRT strategy (alone or combined with surgery [preoperative]) and anti-p53 abs. None of the long-term survivors had p53 abs. KRas abs were found in 19 patients (23%, no difference according to the histological type). There was no significant association between anti-KRas abs and survival neither in the univariate nor in the multivariate analysis. Neither anti-p53 nor anti-KRas abs were associated with response to CRT.ConclusionsAnti-p53 abs are an independent prognostic factor for esophageal cancer patients treated with CRT. Individualized therapeutic approaches should be evaluated in this population.

Comparison of circumferential resection margin clearance criteria with survival after surgery for cancer of esophagus

Circumferential resection margin (CRM) is widely recognized as an important prognostic factor in esophageal cancer. The aim of this study was to evaluate the clinical significance of CRM according to the current criteria of the Royal College of Pathologists (RCP) and the College of American Pathologists (CAP). Patients (115) who underwent esophagectomy between 2000 and 2006 were included in this retrospective study. Factors such as neo-adjuvant therapy, site, histological type, size, and lymph node involvement were tested to determine predictability of CRM involvement. Along with these, age, sex, CRM, and adjuvant therapy were analyzed to determine influence on survival. On the basis of CRM, patients were divided into three groups (involved, 0.1-1 mm and >1mm). Size (T) was the only factor strongly predictive of CRM involvement (P < 0.001). Size (T; P = 0.04) and lymph node involvement (N; P = 0.0003) were found to significantly influence overall survival (OS). When patients with CRM (involved and 0.1-1mm) were compared with those with CRM > 1 mm, OS was significantly prolonged in the latter (P = 0.02). This study appears to lend credence to the RCP criteria for definition of CRM over the CAP criteria.

The significance of lymph node status as a prognostic factor for esophageal cancer

The revision of the TNM Classification of Malignant Tumors, 7th Edition, suggests the lymph node (LN) status to be the most significant risk factor in esophageal cancer. This article reviews the current status of LNs as indicators of prognosis. The significance of the number of metastatic LNs, the number of resected LNs, and a novel index, the "LN ratio" (metastatic LNs/removed LNs) in patients with esophageal cancer, were reviewed. The number of metastatic LNs independently predicted the prognosis of both overall survival and relapse-free survival. The number of positive LNs was also the best predictive marker of survival. Furthermore, overall survival significantly depended on the number of surgically removed LNs, and the LN ratio closely correlated with survival. The LN status is considered to be the most significant information that can be used to predict the prognosis. However, there are many issues that still need to be resolved. Better knowledge of the N-status is therefore needed to effectively utilize this information. Further research should focus on the N-status of patients with esophageal cancer.

Abstract 1905: The association between coffee and green tea intake and upper aerodigestive tract cancer in Japanese population

Abstract [Background] Coffee and tea are the most common beverages worldwide. Specifically, green tea is the most common tea in Japan. Coffee and green tea are potentially thought to have anticancer effect because of the antioxidative components such as chlorogenic acids in coffee and catechins in tea. On the other hand, coffee and green tea are often consumed with high temperature. Hot foods and beverages are considered as risk factor for esophageal cancer (e.g. yarba mate in Latin America). Thus, coffee and green tea might be carcinogenic. Then, we conducted a case-control study to elucidate the association between UAT cancer and coffee and green tea consumption. [Method] Cases were 961 patients with histologically diagnosed as UAT cancer (head and neck cancer in 527 and esophageal cancer in 434) between January 2001 and December 2005 at Aichi Cancer Center Hospital. Controls were 2883 first-visit outpatients who were confirmed to have no cancer during the same period. Cases and Controls were matched by age and sex. Information on coffee and green tea consumption and other lifestyle factors were obtained via self-administered questionnaire. Associations between coffee and green tea consumption and UAT cancer were assessed by odds ratios (ORs) and 95% confidence intervals (CIs) by using conditional logistic regression models. [Result] Both coffee and green tea consumption had significant association with UAT cancer overall (trend p=0.011 and 0.007, respectively). Those who had three or more cups of coffee a day showed significantly lower OR for UAT cancer (OR 0.71, 95% CI 0.55-0.93) than those with non-daily consumers. In contrast, three or more cups of green tea consumption had significant positive association with UAT cancer (OR 1.28, 95% CI 1.06-1.56). These trends were not clear for esophageal cancer. The inverse association between coffee consumption and UAT cancer was evident among current drinkers, while the positive association between green tea and UAT cancer was evident among never drinkers. Similar trends were observed in other categories. [Conclusion] UAT cancer was inversely associated with coffee consumption, and positively associated with green tea consumption. Further epidemiologic studies are warranted. Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 102nd Annual Meeting of the American Association for Cancer Research; 2011 Apr 2-6; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2011;71(8 Suppl):Abstract nr 1905. doi:10.1158/1538-7445.AM2011-1905

Detection of lymph node metastases in esophageal cancer

Lymph node status is the most important single prognostic factor in esophageal cancer. The detection of involved lymph nodes is therefore the key to cure. This article will provide a meta-analysis and metaregression analysis on the diagnostic performances of current lymph node-detection devices; discuss the recent status of the sentinel lymph node concept in esophageal cancer by the two sentinel node-mapping procedures (the radio-guided and the blue dye techniques) and the developing computed tomography (CT) lymphography; discuss the detection of micrometastases; and the potential clinical application of molecular-based patients’ profiles. Combined use of endoscopic ultrasonography fine-needle aspiration and CT significantly improves the diagnostic performance for regional lymph node metastases. Endoscopic ultrasonography is highly sensitive and specific for celiac lymph node metastases, while CT should mostly be performed in order to exclude other abdominal lymph node metastases. Sentinel lymph node navigation may be feasible for cT1N0 or cT2N0 esophageal cancer, and immunohistochemical staining of micrometastatic disease might be feasible in combination with this modality.

Significance of platelet count in esophageal carcinomas

Background/Aim:Thrombocytosis is found to be associated with unfavorable prognosis in esophageal carcinoma. Platelets produce thymidine phosphorylase which is a platelet-derived endothelial cell growth factor with angiogenic activity. Increased platelet count may be translated into enhanced tumor growth. We examined the relation between platelet count and several prognostic variables in patients with esophageal cancer.Patients and Methods:Three hundred and eighty-one cases with esophageal cancer that underwent esophagectomy in a referral cancer institute during a 5-year period were studied retrospectively. The relation between preoperative platelet count and patient age, gender, site of tumor, presence of multiple cancers and clinicopathological characteristics including histological type, tumor size, depth of penetration (T), lymph node involvement (N), distant metastasis (M), degree of differentiation, presence of vascular, lymphatic and perineural invasion was examined.Results:Squamous cell carcinoma (SCC) constituted 93% and adenocarcinoma 7% of cases. Most of patients were in stage III, followed by stage II. The mean platelet count was 245±76 (× 109 /L). There was no statistically significant correlation between platelet counts with prognostic factors except a weak linear correlation between platelet count and and tumor size (P= 0.03, Pearson correlation coefficient: 0.16). Patients with adenocarcinoma had a higher platelet count than those with SCC (P= 0.003).Conclusion:Platelet count does not correlate with prognostic factors in esophageal cancer. However, it is significantly different between SCC and adenocarcinoma of esophagus.

Evaluation of quality control procedures in an oesophageal cancer cohort study in Anyang, China

We wished to evaluate the efficiency of internal quality control procedures of a cohort study investigating human papilloma virus (HPV) infection as a key exposure factor in oesophageal cancer in Anyang, China. This was done by testing 2395 environmental/equipment swab and mock quality control samples from 14 loci on sample collection equipment for human β-globin and HPV DNA. Human β-globin was present in 3.88% of these samples but no HPV DNA was detected. There was no evidence of HPV DNA contamination in the sample collection or processing under the rigorous quality control in our ongoing cohort study. The study results indicated that use of disposable appliances, rigorous environmental cleaning and a high standard of sterilisation of reusable instruments are important in contamination prevention.

W1727 Prognostic and Survival Factors in Esophageal Cancer

W1727 Prognostic and Survival Factors in Esophageal Cancer

The low expression of CD80 correlated with the vascular endothelial growth factor in esophageal cancer tissue

Aims To analyze the mRNA and protein expression of CD80 and vascular endothelial growth factor (VEGF) in esophageal cancer (EC) tissue, investigate the causes of esophageal cancer cell escape from immune surveillance. Methods We detected the CD80 and VEGF mRNA with reverse transcription polymerase chain reaction (RT-PCR), CD80 protein with flow cytometry, VEGF protein with immunohistochemistry in the cancer tissues in 118 EC patients, and the normal esophageal tissue as controls. Results The expression of CD80 mRNA and protein in cancer tissues were lower than that in the controls ( p < 0.01, respectively), The CD80 protein expression in poor differentiation was lower than that in the well and moderate ( P < 0.01), in the patients with lymph node metastasis lower than that with no metastasis ( P = 0.01), in stage IIIA patients lower than that in stages I and II patients ( P = 0.04); the VEGF mRNA and protein expression were just right opposite. The mean survival time in the CD80 positive group was significantly longer than that in the negative ( p = 0.041); while in VEGF positive group was lower than that in the negative ( p = 0.046). The CD80 expression of mRNA and protein were correlated negatively with VEGF in the cancer tissues ( r = −0.82, −0.87, respectively). Conclusion It is suggested that CD80 was impaired in the EC tissues and correlated with the clinicopathological characteristics and prognosis, which indicated the dysfunction of immune system and enhancing the progression of EC. The low expression of CD80 correlated with the overexpression of VEGF.

Epidemiological study of risk factors for esophageal cancer in Yangquan Area of Shanxi Province based on discordant sib pairs

AIM: To explore the main environmental riskfactors for esophageal squamous cell carcinoma (ESCC) based on discordant sib pairs (DSPs) in a moderately high-incidence area, Yangquan City, Shanxi Province, and to provide theoretical evidence for developing effective control and prevention measures in this area. METHODS: A 1∶1 matched case-control study was carried out. One hundred and twenty-seven DSPs were recruited from the cancer registration and follow-up system of the local hospital. All ESCC cases and their matched unaffected sibs were subjected to a survey to obtain demographic information along with personal and family history, and lifestyle factors. The McNemar test was used for data analysis. RESULTS: Compared with matched unaffected sibs, low family income (OR = 2.00, 95%CI: 1.14-3.52, P = 0.0143), hot food eating and drinking (OR = 2.56, 95%CI: 1.44-4.57, P = 0.0009) and heavy drinking (P = 0.0027) were risk factors for ESCC in the area. These factors play important roles in the development of ESCC, even in cases with a family history of ESCC, and the odds ratios (95%CI) were 2.18 (1.07-4.45), 5.00(1.91-13.06) and infi nity, respectively. CONCLUSION: Besides genetic factors, lack of nutrition, hot food eating and heavy drinking are main risk factors for ESCC in Yangquan City. Prevention and control of ESCC should be intervened at multiple levels, such as genetic factors and lifestyles.

The Metastatic Lymph Node Number and Ratio Are Independent Prognostic Factors in Esophageal Cancer

ObjectiveThe current American Joint Committee on Cancer staging system for esophageal cancer is based on lymph node location, irrespective of the number of involved and examined lymph nodes. MethodsWe enrolled 488 patients receiving primary curative resection without neoadjuvant therapy for esophageal cancer between 1995 and 2006. The importance of total resected lymph node number (TLN) and metastatic lymph node number (MLN) and ratio (MLR) on patient survival was investigated. ResultsThe overall 3-year survival rate was 35.4%. The 3-year survival rate was equivalent among patients in N1 (23.3%), M1a (22.0%), and nonregional lymph node metastasis-related M1b (18.5%, p = 0.321). No survival difference was noted between patients with TLN < 15 or ≥15 (p = 0.249). Both MLN and MLR significantly predicted patient survival. The 3-year survival rate was 52.3%, 29.2%, and 8.0% for patients with MLN = 0, 1–3, and ≥4, respectively (p < 0.001). For patients with MLR = 0–0.2 or >0.2, the 3-year survival rate was 28.7% and 9.8%, respectively (p < 0.001). However, survival rate differences were more evident when TLN was more than 15. ConclusionsWe recommend designating both regional and nonregional lymph nodes as N nodes. MLN and MLR, but not TLN, are prognostic factors in esophageal cancer.

Metastasis‐Associated Protein 1 (MTA1) Overexpression is Closely Associated with Shorter Disease‐Free Interval After Complete Resection of Histologically Node‐Negative Esophageal Cancer

The purpose of the present study was to investigate the expression of metastasis-associated protein 1 (MTA1) and its relationship to the disease-free interval after resection of pathologic N0 (pN0) esophageal squamous cell cancer (ESCC). The subjects were 90 patients who successfully underwent complete resection of pN0 ESCC between May 2001 and May 2003. Immunohistochemical staining for MTA1 protein was performed using the avidin-biotin peroxidase complex method. Log-rank test was performed to compare the disease-free interval, and Cox regression multivariate analysis was performed to judge independent prognostic factors. Metastasis-associated protein 1 overexpression was detected in 40 esophageal cancer tissues. Disease-free interval was significantly associated with MTA1 protein overexpression (p = 0.015). The overall 5-year survival rate was 45.6%, the 5-year survival rate of patients with MTA1 protein overexpression was significantly lower than that of those without overexpression (25.0 versus 62.0%; p < 0.001). The results of multivariate analysis confirmed that T status and MTA1 protein overexpression were independent prognostic factors. Metastasis-associated protein 1 overexpression was detected in pN0 ESCC and was significantly correlated with shorter disease-free interval. T status and MTA1 protein overexpression were both independent prognostic factors. These findings suggested MTA1 might be a predictor of relapsing phenotype and a prognostic factor in esophageal cancer.

Immunolocalisation of tissue factor in esophageal cancer is correlated with intratumoral angiogenesis and prognosis of the patient

It has been demonstrated that tissue factor (TF) may be involved in the tumor-derived procoagulatory status and angiogenic modulation in certain solid tumors. In the present study, we examined immunohistochemical localisation of TF in esophageal squamous cell carcinomas (ESCC) from 103 patients. TF immunopositivity was found in 91.3% of all tumor sections, while normal esophageal tissues were immunonegative. Patients were divided into a low TF immunoreactivity group (9 cases of negative and 48 cases of weak positive) and a high TF immunoreactivity group (35 cases of moderate positive and 11 cases of strong positive). TF immunoreactivity was significantly correlated to the presence of distant metastasis (P=0.0014), while it was not correlated to patient's gender, age, tumor size, depth of tumor invasion or lymph node metastasis. Survival analysis revealed that the overall survival rate in the patients that had high TF immunoreactivity was significantly poorer than those with low TF immunoreactivity (P=0.0094). Univariate analysis demonstrated that tumor size (P=0.0095), depth of tumor invasion (P=0.0050), lymph node metastasis (P=0.0045) and distant metastasis (P<0.0001) were effective predictors of prognosis in patients. However, only distant metastasis could independently predict patients' outcomes by the analysis of multivariate proportional hazards regression (P=0.0043). Furthermore, the intratumoral microvessel density (MVD), evaluated by CD34 immunolabeling, indicated that MVD was positively correlated to the TF immunoreactivity (P=0.0056). It is concluded that TF immunopositivity in ESCC tissues is strongly correlated to the intratumoral angiogenesis and to poor patient prognosis.

M1974 Clinicopathological Characteristics of Barrett's Esophageal Cancer in Japanese Patients and Long-Term Results of Therapy

Background: Human papillomavirus (HPV) is increasingly recognized as an important etiological factor of esophageal cancer. However, its prevalence is highly variable between different geographic areas, and is also dependent on the different diagnostic tests such as in situ hybridization, southern blot, and polymerase chain reaction (PCR). Aim: To determine the prevalence of HPV in a selected population of esophageal cancer in Catalonia, Spain. Patients and Methods: Consecutive patients diagnosed with esophageal cancer were selected for the study between February 2007 and September 2008. Paired endoscopic biopsy samples were obtained from normal mucosa and tumour and collected in RNA later. Extracted DNA was amplified using F-HPV typingTM kit PCR (Molgentix, Spain) with a set of 24 fluorescently labelled primers recognizing HPV types 6, 11, 16, 18, 26, 31, 33, 35, 39, 42, 43 , 44, 45, 51, 52, 53, 56, 58, 59, 66, 68, 70, 73 and 82. Results: Twenty patients (mean age: 62 ±11, 16 M/ 4 F) diagnosed with 11 squamous cell carcinoma and 9 with esophageal adenocarcinoma participated in the study. HPV was detected in 6 out of 11 patients (54.5 %) with squamous cell carcinoma and in 1 of 9 patients (11.1%) with adenocarcinoma of esophagus. Medium risk HPV types (53, 70, 73) were detected in 5 out of 7 patients in both tumour and the surrounding normal mucosa. Multi-infection with several medium risk HPV types was found in 4 (57%) of them. Low risk VPH 42 was also present in 5/7 (71%) of cancer samples, three in combination with medium risk VPH, one isolated, and the remaining sample had medium risk HPV 73 in the surrounding normal mucosa. Conclusions: HPV is present in 54% of cases of squamous cell carcinoma in our series. The presence of several medium risk HPV is common in both tumor and normal esophageal mucosa samples from these patients.

M1973 High Prevalence of Human Papillomavirus in a Spanish Population with Esophageal Cancer

Background: Human papillomavirus (HPV) is increasingly recognized as an important etiological factor of esophageal cancer. However, its prevalence is highly variable between different geographic areas, and is also dependent on the different diagnostic tests such as in situ hybridization, southern blot, and polymerase chain reaction (PCR). Aim: To determine the prevalence of HPV in a selected population of esophageal cancer in Catalonia, Spain. Patients and Methods: Consecutive patients diagnosed with esophageal cancer were selected for the study between February 2007 and September 2008. Paired endoscopic biopsy samples were obtained from normal mucosa and tumour and collected in RNA later. Extracted DNA was amplified using F-HPV typingTM kit PCR (Molgentix, Spain) with a set of 24 fluorescently labelled primers recognizing HPV types 6, 11, 16, 18, 26, 31, 33, 35, 39, 42, 43 , 44, 45, 51, 52, 53, 56, 58, 59, 66, 68, 70, 73 and 82. Results: Twenty patients (mean age: 62 ±11, 16 M/ 4 F) diagnosed with 11 squamous cell carcinoma and 9 with esophageal adenocarcinoma participated in the study. HPV was detected in 6 out of 11 patients (54.5 %) with squamous cell carcinoma and in 1 of 9 patients (11.1%) with adenocarcinoma of esophagus. Medium risk HPV types (53, 70, 73) were detected in 5 out of 7 patients in both tumour and the surrounding normal mucosa. Multi-infection with several medium risk HPV types was found in 4 (57%) of them. Low risk VPH 42 was also present in 5/7 (71%) of cancer samples, three in combination with medium risk VPH, one isolated, and the remaining sample had medium risk HPV 73 in the surrounding normal mucosa. Conclusions: HPV is present in 54% of cases of squamous cell carcinoma in our series. The presence of several medium risk HPV is common in both tumor and normal esophageal mucosa samples from these patients.

The degree of circumferential tumour involvement as a prognostic factor in oesophageal cancer☆☆☆

Tumour length is an adverse prognostic factor in oesophageal cancer. However, the prognostic role of the degree of oesophageal circumference (DOC) involved by tumour with or without resection margin invasion is not clear. This work assessed the relationship between DOC involved by tumour, clinico-pathological variables and prognosis. The clinico-pathological details of 320 patients who underwent potentially curative oesophagogastrectomy for cancer between 1994 and 2007 were analysed. The DOC involved with tumour measured macroscopically on the resected specimen was classified as small (<2.5 cm, n = 115), large (> or = 2.5 cm, n = 144) or circumferential (i.e. involving the whole circumference, n = 61). Univariate and multivariate survival analyses were carried out. The DOC with tumour was higher in ulcerating tumours than stenosing or polypoidal types (p = 0.017). Tumour length, T-stage, neoadjuvant chemotherapy and vascular invasion were independently associated with DOC with tumour on multivariate analysis (p < 0.05 for all). DOC > or = 2.5 cm was an adverse prognostic factor in univariate analysis (p = 0.002) with a hazard ratio of 1.52 [95% CI 1.13-2.04] compared with those <2.5 cm. Circumferential tumours had a similar prognosis to tumours > or = 2.5 cm (p = 0.60). The prognostic significance of DOC with tumour was lost in multivariate analysis where the factors retaining independence were patient age, T-stage, lymph node metastasis, vascular invasion and positive resection margins. However, when patients were stratified by use of neoadjuvant chemotherapy (n = 121), the DOC with tumour retained prognostic significance on multivariate analysis in the 199 patients who did not undergo neoadjuvant chemotherapy (p = 0.04). The DOC with tumour appears to provide prognostic information in oesophageal cancer surgery, especially in patients who do not undergo preoperative chemotherapy.

18F-FDG-PET imaging of a benign neurofibroma masquerading as metastatic oesophageal carcinoma

We present the case of a 65-year-old male with squamous cell carcinoma of the thoracic oesophagus on a background of neurofibromatosis type 1. On computed tomography, he was noted to have a large left-sided superior mediastinal mass. Initially, this mass was thought to be metastatic lymphadenopathy; however, it did not display fluorodeoxyglucose uptake on positron emission tomography. Subsequent biopsy confirmed the mass to be a neurofibroma and the patient commenced definitive chemo-radiation. Positron emission tomography had a major impact on management since the presumed lymph node disease was not included in the radiation field. In addition, positron emission tomography altered prognostic stratification since lymph node involvement is a poor prognostic factor in oesophageal cancer. We could only identify one other case in the English literature in which positron emission tomography was used to distinguish metastatic carcinoma from a neurofibroma, although there are a number of reports that describe the utility of positron emission tomography in differentiating benign neurofibromas from malignant connective tissue tumours.

CT overestimates oesophageal tumour length particularly after neoadjuvant chemotherapy: implications for radiotherapy planning

Introduction: Tumour length is an adverse prognostic factor in oesophageal cancer and successful treatment depends on accurate preoperative assessment. This study assessed the level of agreement between preoperative CT and postoperative pathological measurements of oesophageal tumour length, and the relationship between CT tumour length and prognosis.

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

To investigate whether the number of lymph nodes metastasis (LNMs) and the ratio between metastatic and examined lymph nodes (LNs) are better prognostic factors when compared with traditional staging systems in patients with esophageal carcinoma. The accuracy of the 6th UICC/TNM classification is suboptimal, especially when not taking into account neoadjuvant therapy and lymphadenectomy extent. For 536 patients who underwent curative en bloc esophagectomy, in whom 51.5% (n = 276) received neoadjuvant chemoradiation, LNMs were classified according to the 6th UICC/TNM classification and systems based on the number (< or =4 and >4) or the ratio (< or =0.2 and >0.2) of LNMs. Survival of the respective stages, predictors of survival, and influence of both chemoradiation and number of examined LNs were studied. After a median follow-up of 50 months, the 5-year survival rates were 47% for the entire population, significantly poorer for patients with >4 LNMs (8% vs. 53%, P < 0.001) or a ratio of LNMs >0.2 (22% vs. 54%, P < 0.001). After adjustment for confounding variables, a number of LNMs >4 and a ratio of LNMs >0.2 were the only predictors of poor prognosis. The prognostic role of both the number and the ratio of LNMs was maintained whether patients received neoadjuvant chemoradiation or not. Moreover, LN ratio is shown to be more accurate for inadequately staged patients (<15 examined LNs), whereas the number of LNMs is pertinent for adequately staged patients (> or =15 examined LNs). Staging systems for esophageal cancer that use the number (< or =4 or >4) and the ratio (< or =0.2 or >0.2) of LNMs have greater prognostic importance than the current staging systems because of the good stratification of the groups and their clinical utility, taking into account neoadjuvant therapy and lymphadenectomy extent.