the significance of extracapsular lymph node involvement in node- positive patients with...
TRANSCRIPT
The significance of extracapsular lymph node involvement in node-positive patients with adenocarcinoma of the distal oesophagus or
gastro-oesophageal junction
J Sultan, S Allan, N Hayes, SM Griffin
Northern Oesophago-Gastric Cancer Unit, Royal Victoria Infirmary,
Newcastle upon Tyne
Introduction
• 5 year survival
• Extracapsular lymph node involvement (ECLNI)
• Limited publications
• No UK studies
Aims
• To study the effect of ECLNI in patients undergoing subtotal
oesophagectomy for ACA:
1. Proportion of patients with ECLNI
2. Cancer specific survival
1. 3 year survival and stage of disease
2. Cancer specific survival using the number of nodes involved with extracapsular spread
Methods• Prospective database
• Subtotal Oesophagectomy for ACA
• January 2006 to January 2013 (n=363)
• Node positive disease
• TNM 7th edition
• SPSS version 19
Results
Total numbern = 363
Node positive diseasen=180
ECLNIn = 100
Node negative diseasen=183
ICLNIn = 80
27.5% with ECLNI
Patient data and outcome
ICLNI
n=80
ECLNI
n=100
p
value
Age (years) 65 65 0.973
M:F 3.2:1 10.1:1 0.012
Neo-adjuvant chemo 31.7% 43.3% 0.104
R0 resection 98.8% 94% 1.000
BMI 26.9 25.9 0.077
Blood transfusion 7.5% 5% 0.452
Operation time (mins) 357 360 0.621
Blood loss (mls) 530 590 0.585
Critical care stay (days) 2 2 0.784
Length of hospital stay (days) 19 17 0.333
Morbidity 64% 58% 0.447
Mortality 1.3% 2% 1.000
HistologyICLNI
n=80
ECLNI
n=100
p
value
Stage of disease 2b
3a
3b
3c
30%
38%
21%
11%
7%
23%
20%
50%
0.001
Venous involvement 44% 60% 0.036
Perineural involvement 50% 78% 0.001
Tumour differentiation
Well differentiated
Moderately differentiated
Poorly differentiated
9%
46%
45%
2%
45%
53%
1.000
Histology
ICLNI
n=80
ECLNI
n=100
p
value
Total number of nodes removed 34 34 0.483
Nodal status n1
n2
n3
56%
35%
9%
24%
27%
49%
0.001
Total number of positive nodes 2 6 0.001
Ratio of positive nodes:nodes removed
7% 18% 0.001
Survival
p<0.001
Median Survival (months)
ICLNI
n=80
ECLNI
n=100
p
value
Stage 2b
n=31
- 21.6 0.172
Stage 3a
n=53
36.6 32.6 0.590
Stage 3b
n=37
79.8 25.8 0.185
Stage 3c
n=59
21.8 15.5 0.347
Overall p<0.001
3 year Survival
ICLNI
n=80
ECLNI
n=100
p
value
Stage 2b 75% 43% 0.172
Stage 3a 60% 52% 0.590
Stage 3b 71% 45% 0.185
Stage 3c 33% 16% 0.347
Overall p<0.001
Survival
Overall Survival
(months)
95% CI
(months)
p
value
ICLNI 46.6 17.6 – 75.6
0.001
1 or 2 nodes with ECLNI 26.0 17.0 – 35.0
3 – 6 nodes with ECLNI 18.5 10.9 - 26.1
Over 7 nodes with ECLNI 16.5 11.0 – 22.0
Overall survival
p<0.001
Conclusion
Extracapsular lymph node involvement in node-positive patients with adenocarcinoma of the distal oesophagus or gastro-
oesophageal junction is a negative prognostic indicator and should be incorporated into the TNM classification