Impact of pathologically assessing extranodal extension in the thoracic field on the prognosis of esophageal squamous cell carcinoma |
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Authors: | Naoya Okada Hiroyuki Daiko Jun Kanamori Ataru Sato Yasumasa Horikiri Takuji Sato Hisashi Fujiwara Toshifumi Tomioka Takeo Fujita Takashi Kojima Satoshi Fujii |
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Institution: | 1. Esophageal Surgery Division, Department of Gastrointestinal Oncology, National Cancer Center Hospital, Tsukiji, Chuo-ku, Tokyo, Japan;2. Department of Esophageal Surgery, National Cancer Center Hospital East, Kashiwa, Chiba, Japan;3. Department of Head and Neck Surgery, National Cancer Center Hospital East;4. Department of Gastrointestinal Oncology & Endoscopy, National Cancer Center Hospital East;5. Division of Pathology, Exploratory Oncology Research & Clinical Trial Center, National Cancer Center, Kashiwa, Chiba, Japan |
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Abstract: | BackgroundThis study aimed to elucidate the impact of extranodal extension, pathologically assessed according to new diagnostic criteria, on the prognosis of esophageal squamous cell carcinoma. Extranodal extension has been shown to be a prognostic indicator for head and neck cancers; however, its utility in esophageal squamous cell carcinoma has not been demonstrated.MethodsWe enrolled 174 consecutive esophageal squamous cell carcinoma patients who had undergone esophagectomy with lymph node dissection in the three fields. Extranodal extensions from all metastatic lymph nodes were pathologically classified into grades 1–3. Then, relationships between extranodal extension and clinicopathologic factors, including overall survival and recurrence-free survival were examined. Recurrence patterns in the thoracic and abdominal fields were also examined.ResultsKaplan–Meier analyses showed that patients with grades 2 and 3 extranodal extension showed significantly poorer recurrence-free survival compared with those with intranodal involvement of esophageal squamous cell carcinoma cells (P = .0041 and P = .0011, respectively). Patients with pN3b (newly defined in this study as including at least one lymph node with grade 2–3 extranodal extension regardless of region or number of metastatic lymph nodes) was associated with significantly shorter overall survival and recurrence-free survival (P < .001). Moreover, multivariate analyses indicated that patients with grades 2–3 extranodal extension showed significantly reduced recurrence-free survival in the thoracic but not in the abdominal field (thoracic: P = .047; abdominal: P = .15).ConclusionThis study suggests that the extranodal extension grading system proposed in this study is a novel predictor of overall survival and recurrence-free survival in esophageal squamous cell carcinoma. |
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Keywords: | Reprint requests: Satoshi Fujii MD PhD Division of Pathology Exploratory Oncology Research & Clinical Trial Center National Cancer Center 6-5-1 Kashiwanoha Kashiwa Chiba 277-8577 Japan |
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