ESOPHAGEAL-CARCINOMA - DEPTH OF TUMOR INVASION IS PREDICTIVE OF REGIONAL LYMPH-NODE STATUS

Background. The depth of tumor invasion (T) and regional lymph node st atus (N) are two factors that define the stage of an esophageal carcin oma. However, the arrangement of staging groups assumes that these fac tors are independent variables. A retrospective review of 359 consecut ive patients undergoing esophageal resection was conducted to define t he relationship between T and N and to determine whether T is a signif icant predictor of regional lymph node metastasis (N1). Methods. Prima ry treatment was operation without preoperative therapy. There were 29 5 (82%) adenocarcinomas, 55 (15%) squamous cell carcinomas, and 9 (3%) adenosquamous carcinomas. T status was Tis in 29 (8%) patients, T1 in 65 (18%), T2 in 37 (10%), T3 in 219 (61%), and T4 in 9 (3%). N status was NO in 161 (45%) patients and N1 in 198 (55%). M status was MO in 327 (91%) patients and M1 in 32 (9%). Stage was 0 in 29 (8%) patients, I in 58 (16%), IIA in 70 (20%), IIB in 22 (6%), III in 148 (41%), and IV in 32 (9%). Results, The likelihood of N1 disease occurring with i ncreasing T was tested using the trend test. The percentage of patient s with N1 disease is 0% for Tis, 11% for T1, 43% for T2, 77% for T3, a nd 67% for T4 (p < 0.001). This relationship existed for both adenocar cinoma and squamous cell carcinoma. Multivariable analysis identified increasing T, adenocarcinoma, and lack of well-differentiated histolog ic features as significant predictors of N1 disease. Compared with a T 1 patient, a T2 patient is 6 times more likely to have N1 disease, a T 3 patient 23 times, and a T4 patient 35 times. Conclusions. We conclud e that for patients with esophageal carcinoma, T is an important predi ctor of N and this association should be included with other establish ed factors used in clinical staging and treatment decisions.