The prognostic importance of the number of involved lymph nodes in esophageal cancer: Implications for revisions of the American Joint Committee on Cancer.

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Presentation transcript:

The prognostic importance of the number of involved lymph nodes in esophageal cancer: Implications for revisions of the American Joint Committee on Cancer staging system Nabil Rizk, MD, Ennapadam Venkatraman, PhD, Bernard Park, MD, Raja Flores, MD, Manjit S. Bains, MD, Valerie Rusch, MD The Journal of Thoracic and Cardiovascular Surgery Volume 132, Issue 6, Pages 1374-1381.e2 (December 2006) DOI: 10.1016/j.jtcvs.2006.07.039 Copyright © 2006 The American Association for Thoracic Surgery Terms and Conditions

Figure 1 Kaplan-Meier analysis of overall survival showed poor discrimination between stages IIa and IIb (P = .71), as well as between stages IVa and IVb (P = .81). The Journal of Thoracic and Cardiovascular Surgery 2006 132, 1374-1381.e2DOI: (10.1016/j.jtcvs.2006.07.039) Copyright © 2006 The American Association for Thoracic Surgery Terms and Conditions

Figure 2 Recursive partitioning analysis using the variables T, N, and M (M1b and M1) essentially recreates the AJCC staging system with the exception of the M descriptor. AJCC, American Joint Committee on Cancer. The Journal of Thoracic and Cardiovascular Surgery 2006 132, 1374-1381.e2DOI: (10.1016/j.jtcvs.2006.07.039) Copyright © 2006 The American Association for Thoracic Surgery Terms and Conditions

Figure 3 Recursive partitioning analysis that includes the number of involved lymph nodes as a variable in addition to T, N, and M (M1b and M1) identified the presence of more than 4 involved lymph nodes as the single most important discriminator of survival, irrespective of T stage. The Journal of Thoracic and Cardiovascular Surgery 2006 132, 1374-1381.e2DOI: (10.1016/j.jtcvs.2006.07.039) Copyright © 2006 The American Association for Thoracic Surgery Terms and Conditions

Figure 4 In T2-3 tumors, patients with no positive lymph nodes have the best prognosis, and patients with 4 or more positive lymph nodes have the worst prognosis. The Journal of Thoracic and Cardiovascular Surgery 2006 132, 1374-1381.e2DOI: (10.1016/j.jtcvs.2006.07.039) Copyright © 2006 The American Association for Thoracic Surgery Terms and Conditions

Figure 5 Among of T2-3 tumors with 0 to 4 involved lymph nodes, survival was significantly better if more than 18 lymph nodes were removed. The Journal of Thoracic and Cardiovascular Surgery 2006 132, 1374-1381.e2DOI: (10.1016/j.jtcvs.2006.07.039) Copyright © 2006 The American Association for Thoracic Surgery Terms and Conditions

Figure 6 In patients with an adequate lymphadenectomy (>18 lymph nodes removed), depth of invasion is no longer a significant predictor of survival. The Journal of Thoracic and Cardiovascular Surgery 2006 132, 1374-1381.e2DOI: (10.1016/j.jtcvs.2006.07.039) Copyright © 2006 The American Association for Thoracic Surgery Terms and Conditions

Figure E1 Recursive partitioning analysis using T, N, M as variables. The Journal of Thoracic and Cardiovascular Surgery 2006 132, 1374-1381.e2DOI: (10.1016/j.jtcvs.2006.07.039) Copyright © 2006 The American Association for Thoracic Surgery Terms and Conditions

Figure E2 Recursive partitioning analysis using T, N, M and number of positive lymph nodes as variables. LN, Lymph nodes. The Journal of Thoracic and Cardiovascular Surgery 2006 132, 1374-1381.e2DOI: (10.1016/j.jtcvs.2006.07.039) Copyright © 2006 The American Association for Thoracic Surgery Terms and Conditions

Figure E3 Recursive partitioning analysis using T, N, M, number of positive lymph nodes, and total number of lymph nodes as variables. LN, Lymph nodes. The Journal of Thoracic and Cardiovascular Surgery 2006 132, 1374-1381.e2DOI: (10.1016/j.jtcvs.2006.07.039) Copyright © 2006 The American Association for Thoracic Surgery Terms and Conditions

Figure E4 Recursive partitioning analysis using T, N, M and total number of lymph nodes as variables in patients with more than 18 lymph nodes removed. LN, Lymph nodes. The Journal of Thoracic and Cardiovascular Surgery 2006 132, 1374-1381.e2DOI: (10.1016/j.jtcvs.2006.07.039) Copyright © 2006 The American Association for Thoracic Surgery Terms and Conditions