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Clinical Impact of Lymphadenectomy Extent in Resectable Esophageal Cancer
Roderich E. Schwarz*1, David D. Smith2
1Dept. of Surgery, UMDNJ-RWJMS, CINJ, New Brunswick, NJ; 2Biostatistics, City of Hope Cancer Center, Duarte, CA

Background: Esophageal cancer (EC) frequently presents with advanced stages, and is associated with high recurrence rates after esophagectomy. The value of an extended lymph node dissection (ELND) remains unclear in this setting.
Methods: An esophageal cancer data set was created through structured queries to the SEER 1973-2003 database. Relationships between the number of LNs examined and overall survival (OS) were analyzed for all histologic types.
Results: From a cohort of 40,129 patients, 7,971 individuals were selected based on completeness of information. The median age was 65 (range: 11-102), and 75% of patients were male. The median tumor size was 5.0 cm (0.1-30). On multivariate analysis, total LN count (or negative LN count, respectively) was an independent prognostic variable, aside from positive LN number, T category, tumor size, grade, age, year of diagnosis, radiation therapy (all at p<0.0001), gender (p=0.0008), histology (p=0.004), resection, M category, race (all at p=0.01), and primary site (p=0.02). Higher total LN count (up to >30) and negative LN count (up to >15) categories were associated with the best OS (p<0.0001, see Table and Figures).
Conclusions: More extensive LN dissection and analysis influence EC survival. Survival prediction depends on both total LN number and number of negative LNs obtained. While the mechanism remains uncertain, ELND during potentially curative esophagectomy for EC can be supported by the data.
Overall Survival, by total and negative LN counts

Category Subgroup n Median OS 1-year OS 2-year OS 5-year OS 10-year OS
Total LN counts0 LNs examined 8113 8 months 36% 20% 9% 5%
1 LN 370 1.1 years 51% 32% 18% 10%
2-4 LNs 777 1.6 years 62% 44% 25% 13%
5+ LNs 2853 1.8 years 67% 47% 28% 18%
Negative LN counts0 LNs negative 312 8 months 34% 13% 5% 4%
1-2 LN negative 701 1.2 years 54% 35% 20% 14%
3+ LNs negative 2972 2.1 years 70% 51% 31% 18%

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