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- Title
B-005CAN EXTRACAPSULAR LYMPH NODE INVOLVEMENT BE A TOOL TO FINETUNE PN1 FOR ADENOCARCINOMA IN INTERNATIONAL UNION AGAINST CANCER TNM 7TH EDITION?
- Authors
Nafteux, Philippe; Van Veer, H.; Moons, J.; Lerut, T.; Coosemans, W.; Decker, G.; Decaluwe, H.; Van Raemdonck, D.; De Leyn, P.
- Abstract
Objectives The current (7th) International Union Against Cancer (UICC) pN staging system is based on the number of positive lymph nodes but does not take into consideration characteristics of the metastatic lymph nodes itself. The aim of the current study was to examine the prognostic value of extracapsular (EC-LNI) and intracapsular (IC-LNI) lymph node involvement in oesophageal cancer. Methods From 1990-2010, 792 adenocarcinoma patients with primary R0 resection were retrieved from our prospective database. The number of resected lymph nodes, number of positive lymph nodes and number of EC-LNI/IC-LNI were determined. Extracapsular spread was defined as infiltration of cancer cells beyond the capsule of the positive lymph node. Results Four hundred and eight (51.5%) patients had positive lymph nodes. In 227 (55.6%) cases EC-LNI was detected. EC-LNI showed significantly worse cancer-specific 5-year survival compared to IC-LNI, 20.5% vs 40.7% (P < 0.0001). In the pN1-category (1 or 2 positive LNs–UICC stages IIB and IIIA) this was 30.2% vs 48.8%; P = 0.0035). In higher UICC stages, this effect was no longer noticed. UICC stages IIB/IIIA, EC-LNI patients show survival rates that are more closely associated with stage IIIB, while IC-LNI patients have a survival more similar to stage IIB. Reclassifying stages IIB/IIA in IC- and EC-LNI, homogeneity of the TNM model increases (log-rank Chi square increases from 372.8 to 379.7; df[8]). Conclusions EC-LNI is associated with worse survival compared to IC-LNI. In current UICC stages IIB/IIIA, EC-LNI patients show survival rates that are more closely associated with stage IIIB, while IC-LNI patients have a survival more similar to stage IIB. In future adaptations of the staging system for oesophageal cancer, EC-LNI vs IC-LNI should be considered. Disclosure All authors have declared no conflicts of interest.
- Publication
Interactive Cardiovascular & Thoracic Surgery, 2013, Vol 17, Issue suppl_1, pS1
- ISSN
1569-9293
- Publication type
Article
- DOI
10.1093/icvts/ivt288.5