Extracapsular lymph node involvement: A negative prognostic factor for esophageal cancer

The presence and extent of lymphatic dissemination are among the most important predictors for survival in gastrointestinal malignancies. Little is known about the effects of neoadjuvant chemoradiotherapy (CRT) on the presence of extracapsular lymph node involvement (LNI) and its prognostic value in patients with resected esophageal cancer. A study group led by Metzger from Germany found that extracapsular LNI is not influenced by neoadjuvant CRT.

There is increasing evidence to include combined neoadjuvant chemoradiotherapy (CRT) as an alternative to surgical resection alone, to improve survival for locoregional esophageal cancer. More recently, attention has focused on the presence of extracapsular lymph node involvement (LNI), which identifies a subgroup of patients with significantly worse long-term survival. Little is known about the effects of neoadjuvant chemoradiotherapy (CRT) on the presence of extracapsular LNI and its prognostic value in patients with resected esophageal cancer.

A research article to be published in April 28, 2010 in the World Journal of Gastroenterology addresses this question. The research team, led by Dr. Metzger R and Dr. Hölscher AH from the Department of General, Visceral, and Cancer Surgery, Center for Integrated Oncology, University of Cologne, Germany investigated the effects of neoadjuvant CRT on the presence of extracapsular LNI and its prognostic value in patients with resected esophageal cancer. Two hundred and ninety-eight patients with advanced esophageal cancer underwent esophagectomy, of whom 68.8% were treated with neoadjuvant CRT prior to resection. A total of 986 metastatic LNs were examined.

The results support the hypothesis that extracapsular LNI is not influenced by neoadjuvant CRT and identifies a subgroup of esophageal cancer patients with a significantly worse long-term survival. Therefore extracapsular LNI should be noted as a negative prognostic factor and should be taken into account for a revised staging system for esophageal cancer.