Esophageal cancer with distant lymph node metastasis - Prognostic significance of metastatic lymph node ratio

The cervical and celiac lymph node metastases are defined as distant metast asis (Mlym) from thoracic esophageal carcinoma by TNM (primary tumor, regio nal lymph nodes, and distant metastasis) classification. The prognostic fac tors, however, of such distant node metastases are not fully understood. Of 85 patients with node-positive thoracic esophageal carcinoma who were trea ted with the same modalities of treatment, 31 (37%) had Mlym. Prognostic fa ctors for long-term survival were analyzed by univariate and multivariate a nalyzes. Three patients are alive and free of cancer, and two patients surv ived over 5 years. Fifteen patients died of recurrent esophageal cancer and 11 patients succumbed to causes unrelated to esophageal cancer. Two patien ts with a single Mlym died without recurrence of esophageal cancer at 1.4 y ears and after more than 5 years, respectively. The 1-, 2-, 3-, and 5-year overall survival rates of all 31 patients were 64.5%, 24.8%, 17.0%, and 12. 8%, respectively. The factors influencing survival rate were depth of invas ion (pT1,2 vs, pT3,4) and metastatic lymph node ratio (less than or equal t o0.104 vs. greater than or equal to0.105). The survival rates were not infl uenced by number of lymph node metastasis, number of Mlym, or by metastatic lymph node ratio of Mlym. Among those two significant variables verified b y univariate analysis, independent prognostic factor for survival determine d by multivariate analysis was the metastatic lymph node ratio (risk ratio = 3.4, p = 0.0345). The results of this study indicate that a significant n umber of patients can be cured of esophageal carcinoma by extensive resecti on along with extended lymph node dissection even when the disease metastas izes to distant nodes.