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2001 Abstract: 2436 Esophageal Carcinoma: Importance and Associations of N1 Burden

2001 Digestive Disease Week

# 2436 Esophageal Carcinoma: Importance and Associations of N1 Burden
Thomas W. Rice, Eugene H. Blackstone, Malcolm M. DeCamp, Sudish C. Murthy, Lisa A. Rybicki, John Goldblum, David J. Adelstein, Cleveland, OH

An increasing number of regional lymph node metastases (N1 burden) is associated with a worsening prognosis in patients with esophageal carcinoma. Aim: To quantify the effect of N1 burden on survival and to identify predictors of N1 burden.

Methods: Analysis of a prospective database of 606 patients undergoing resection of esophageal carcinoma at a single institution. The effect of N1 burden on survival was quantified by multivariable hazard function analysis. The predictors of N1 burden were identified by ordinal logistic regression.

Results: Of 606 patients, 243 with pathologic N1 nodes (pN1) received surgery without preoperative induction therapy. One-year and 5-year survival according to N1 burden is displayed in Fig. 1. Multivariable analysis of 606 patients identified total number of nodes resected (odds ratio (OR)=1.08/node, P<.0001), adenocarcinoma (OR=2.9, P<.0001), depth of tumor invasion (T) (T1 OR=4.9, P=.002, T2 OR=12.0, P<.0001, T3 and T4 OR=54, P<.0001) and non-regional lymph node metastases (M1a) (OR=5.0, P<.0001) as predictors of increased N1 burden. Treatment with induction chemoradiotherapy (OR=0.60, P=.02) was the only predictor of decreased N1 burden.

Conclusions: 1) Lymphadenectomy is essential for prognostication. 2) Survival decays exponentially with increasing N1 burden, thus there is no evident survival difference for patients with more than 3 N1 nodes or more than 15% of N1 nodes in the resection specimen. 3) A patient with adenocarcinoma invading beyond the esophageal wall (T3 or T4) and not receiving induction therapy is at highest risk of increased N1 burden and thus poor survival.

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