Get access

The assessment of prognosis of surgically resected oesophageal cancer is dependent on the number of lymph nodes examined pathologically

Authors

  • Christopher P Twine,

    1. South East Wales Cancer Network; Department of General and Upper GI Surgery, University Hospital of Wales, Cardiff, 1Department of General Surgery, Royal Glamorgan Hospital, Llantrisant, 2Department of Oncology, Velindre Hospital, School of Medicine, Cardiff University, 3Department of Radiology, University Hospital of Wales and 4Department of Pathology, School of Medicine, Cardiff University, Cardiff, UK
    Search for more papers by this author
  • Wyn G Lewis,

    1. South East Wales Cancer Network; Department of General and Upper GI Surgery, University Hospital of Wales, Cardiff, 1Department of General Surgery, Royal Glamorgan Hospital, Llantrisant, 2Department of Oncology, Velindre Hospital, School of Medicine, Cardiff University, 3Department of Radiology, University Hospital of Wales and 4Department of Pathology, School of Medicine, Cardiff University, Cardiff, UK
    Search for more papers by this author
  • Matthew A Morgan,

    1. South East Wales Cancer Network; Department of General and Upper GI Surgery, University Hospital of Wales, Cardiff, 1Department of General Surgery, Royal Glamorgan Hospital, Llantrisant, 2Department of Oncology, Velindre Hospital, School of Medicine, Cardiff University, 3Department of Radiology, University Hospital of Wales and 4Department of Pathology, School of Medicine, Cardiff University, Cardiff, UK
    Search for more papers by this author
  • David Chan,

    1. South East Wales Cancer Network; Department of General and Upper GI Surgery, University Hospital of Wales, Cardiff, 1Department of General Surgery, Royal Glamorgan Hospital, Llantrisant, 2Department of Oncology, Velindre Hospital, School of Medicine, Cardiff University, 3Department of Radiology, University Hospital of Wales and 4Department of Pathology, School of Medicine, Cardiff University, Cardiff, UK
    Search for more papers by this author
  • Geoffrey W B Clark,

    1. South East Wales Cancer Network; Department of General and Upper GI Surgery, University Hospital of Wales, Cardiff, 1Department of General Surgery, Royal Glamorgan Hospital, Llantrisant, 2Department of Oncology, Velindre Hospital, School of Medicine, Cardiff University, 3Department of Radiology, University Hospital of Wales and 4Department of Pathology, School of Medicine, Cardiff University, Cardiff, UK
    Search for more papers by this author
  • Tim Havard,

    1. South East Wales Cancer Network; Department of General and Upper GI Surgery, University Hospital of Wales, Cardiff, 1Department of General Surgery, Royal Glamorgan Hospital, Llantrisant, 2Department of Oncology, Velindre Hospital, School of Medicine, Cardiff University, 3Department of Radiology, University Hospital of Wales and 4Department of Pathology, School of Medicine, Cardiff University, Cardiff, UK
    Search for more papers by this author
  • 1 Tom D Crosby,

    1. South East Wales Cancer Network; Department of General and Upper GI Surgery, University Hospital of Wales, Cardiff, 1Department of General Surgery, Royal Glamorgan Hospital, Llantrisant, 2Department of Oncology, Velindre Hospital, School of Medicine, Cardiff University, 3Department of Radiology, University Hospital of Wales and 4Department of Pathology, School of Medicine, Cardiff University, Cardiff, UK
    Search for more papers by this author
  • 2 S Ashley Roberts,

    1. South East Wales Cancer Network; Department of General and Upper GI Surgery, University Hospital of Wales, Cardiff, 1Department of General Surgery, Royal Glamorgan Hospital, Llantrisant, 2Department of Oncology, Velindre Hospital, School of Medicine, Cardiff University, 3Department of Radiology, University Hospital of Wales and 4Department of Pathology, School of Medicine, Cardiff University, Cardiff, UK
    Search for more papers by this author
  • and 3 Geriant T Williams 4

    1. South East Wales Cancer Network; Department of General and Upper GI Surgery, University Hospital of Wales, Cardiff, 1Department of General Surgery, Royal Glamorgan Hospital, Llantrisant, 2Department of Oncology, Velindre Hospital, School of Medicine, Cardiff University, 3Department of Radiology, University Hospital of Wales and 4Department of Pathology, School of Medicine, Cardiff University, Cardiff, UK
    Search for more papers by this author

Mr W G Lewis, Consultant Surgeon, Cardiff and Vale NHS Trust, University Hospital of Wales, Heath Park, Cardiff CF14 4XW, UK. e-mail: wyn.lewis@cardiffandvale.wales.nhs.uk

Abstract

Aims:  The prognosis in surgically resected oesophageal carcinoma (OC) is dependent on the number of regional lymph nodes (LN) involved, but no guidance exists on how many LNs should be examined histopathologically to give a reliable pN status. The aim of this study was to determine whether the number of LNs examined after OC resection has a significant effect on the assessment of prognosis.

Methods and results:  Routinely generated pathology reports from 237 consecutive patients undergoing oesophagectomy for OC were examined and analysed in relation to survival. The main outcome measure was survival from date of diagnosis. Lymph node count (LNC) correlated strongly with survival; a plateau was reached after a count of 10. Median and 2-year survival was 30 months and 42%, respectively, if <10 nodes were examined (n = 88), compared with 51 months and 61% if >10 nodes were examined (P = 0.005). This effect was greatest in pN0 cases. The prognostic value of the absolute number of LN metastases (<4) and LN ratio (<0.4) was strongly dependent on a LNC of >10.

Conclusions:  These results demonstrate the importance of careful pathological examination and lymph node retrieval after OC resection. At least 10 nodes should be examined to designate an OC as pN0.

Ancillary