Number of lymph node metastases determined by presurgical ultrasound and endoscopic ultrasound is related to prognosis in patients with esophageal carcinoma

Objective To analyze the impact on prognosis of the number of lymph node me tastases detected by ultrasound and endoscopic ultrasound in patients with esophageal carcinoma. Summary Background Data Ultrasound and endoscopic ultrasound are useful for diagnosing tumor depth and lymph node metastasis in patients with esophage al carcinoma. However, the clinical significance of the number of lymph nod e metastases before surgery has not been elucidated. Methods The authors evaluated lymph node metastases using preoperative ultr asound and endoscopic ultrasound in 329 consecutive patients who underwent esophagectomy with lymphadenectomy. TNM classification and one-to-one compa rison of lymph node metastasis was performed between the preoperative and h istologic diagnosis. The number of lymph node metastases was subdivided int o four groups: zero, one to three, four to seven, and eight or more. Results The accuracy of preoperative ultrasound and endoscopic ultrasound d iagnosis exceeded 70% in each category of TNM classification, The incidence of lymph node metastasis determined by preoperative and histologic diagnos is was 69.0% (234/339) and 59.3% (201/339), respectively. The correlation b etween preoperative and histologic diagnosis was significant (P < .0001). A ccording to the subdivision of number of lymph node metastases, the accurac y rates associated with nodal involvement of zero, one to three, four to se ven, and eight or more were 83.8%, 59.7%, 43.3%, and 96.0%, respectively. T he clinical outcome between ultrasound and endoscopic ultrasound diagnosis and histologic diagnosis in stage grouping was almost similar. The 5-year s urvival rates of patients with zero, one to three, four to seven, and eight or more lymph node metastases determined by ultrasound and endoscopic ultr asound were 53.3%, 33.8% 17.0%, and 0%, respectively. The differences among groups were statistically significant. The survival curves associated with preoperative and histologic diagnosis were similar. Conclusions Not only the stage grouping of TNM classification but also the number of lymph node metastases determined by ultrasound and endoscopic ult rasound before surgery may be useful for predicting prognosis in patients w ith esophageal carcinoma.