Lymph node micrometastases in patients with adenocarcinoma of the esophagogastric junction

Recurrences of adenocarcinoma of the esophagogastric junction are frequent even in patients who are classified as pN0 after radical resection, suggest ing that occult nodal metastases may have been missed on routine histologic examination. Immunohistochemical analysis using antibodies to cytokeratin was retrospectively performed in 1301 lymph nodes from 46 patients who unde rwent surgical resection for adenocarcinoma of the esophagogastric junction through a laparotomy and a right thoracotomy. Compared to routinely staine d sections, the total number of metastatic lymph nodes was significantly (P = 0.0001) increased when both serial sectioning and anticytokeratin immuno histochemical analysis were performed. Overall 6 (33.3%) of the 18 patients previously considered NO were recategorized as N1 for the presence of micr ometastases to lesser curvature nodes. Three of these patients had recurren t disease within the first year of follow-up. Both the probability of survi val or no recurrence and the disease-free survival were significantly great er in patients in whom the ratio of invaded to removed lymph nodes was less than 0.2. Anticytokeratin analysis identified occult nodal metastases in o ne third of our patients with adenocarcinoma of the esophagogastric junctio n. This modified tumor staging and had an impact on overall and disease-fre e survival.