Predictors of survival for esophageal cancer patients with and without celiac axis lymphadenopathy: Impact of staging endosonography

Background. Esophageal cancer patients with M1a disease are reported to hav e poor survival. We hypothesized that patients with celiac lymph node metas tases (CLN) identified by endoscopic ultrasonography (EUS) would predict a cohort with significantly worse survival postoperatively. Accurate preopera tive identification of this group will facilitate future adjuvant studies. Methods. During the study period, 211 patients with esophageal cancer under went EUS staging. Patients with evaluable celiac axis (n = 182) were includ ed in this study. Survival of patients with and without CLNs was compared a nd the factors affecting overall survival were assessed. A subgroup analysi s based on CLN status was performed in the subgroup of patients who underwe nt surgical procedures. Results. Follow-up data was available in 91.2% (166 of 182) of the patients . As staged by EUS, T1, T2, T3, and T4 tumors accounted for 9.3%, 11.5%, 56 %, and 21% of the cases, respectively. At least one CLN was imaged by EUS i n 40% (72 of 182). The 5-year survival in patients with CLNs detected by EU S was 13% (95% confidence interval, 5% to 21%) compared with 30% (95% confi dence interval, 21% to 40%) in patients with no CLNs detected by EUS (p = 0 .007). In the subgroup of patients who underwent surgical procedures (n = 6 8), patients with CLN involvement had worse survival compared with, those w ho did not have malignant involvement of CLNs at the time of their operatio n (median survival 39.8 versus 13.8 months, p = 0.0008). In a Cox proportio nal model, adjusting for race and the type of therapy, patients with CLN in volvement or advanced EUS American Joint Committee on Cancer stage were mor e likely to have worse survival (p < 0.05) Conclusions. EUS base line findings correlate with long term survival in pa tients with Esophageal cancer. Patients with M1a disease as identified by E US had a significantly worse postoperative survival when compared with non- M1a patients. This cohort of patients will be ideal fur the study of induct ion therapy since the effect of down staging can be assessed before operati on. (C) 2001 by The Society of Thoracic Surgeons.