Ratio of invaded to removed lymph nodes as a predictor of survival in squamous cell carcinoma of the oesophagus

TLDR

The study evaluated 186 squamous cell oesophageal cancer patients who all received standardized en bloc oesophagectomy with systematic lymph node dissection and were prospectively followed to completion. Multivariate analysis revealed that residual tumour status (R category) was the most powerful independent prognostic factor, with the ratio of invaded to removed lymph nodes also significantly predicting survival, suggesting that only patients likely to achieve R0 resection should undergo primary surgery and that extended lymphadenectomy may benefit those with few invaded mediastinal nodes.

Abstract

Prognostic factors that may alter the indications for primary surgical resection or that can be influenced by the extent of the procedure were analysed in a homogeneous group of 186 patients with squamous cell carcinoma of the oesophagus. All patients underwent standardized en bloc oesophagectomy and lymph node dissection with prospective documentation of the histopathological findings; follow-up was complete. Multivariate analysis identified the Union Internacional Contra la Cancrum R category (i.e. the presence of residual tumour after resection) as the most important independent prognostic factor (P < 0.001) followed by the ratio of invaded to removed lymph nodes (P < 0.001). These data suggest that only patients in whom R0 resection can be anticipated based on preoperative assessment should undergo primary resection for oesophageal cancer. Extended lymphadenectomy may improve survival in patients with a limited number of invaded mediastinal nodes.