The significance of extracapsular lymph node involvement in node-positive patients with adenocarcinoma of the distal oesophagus or

gastro-oesophageal junction 

J Sultan, S Allan, N Hayes, SM Griffin

Northern Oesophago-Gastric Cancer Unit, Royal Victoria Infirmary,

Newcastle upon Tyne

Introduction

• 5 year survival

• Extracapsular lymph node involvement (ECLNI)

• Limited publications

• No UK studies

Aims

• To study the effect of ECLNI in patients undergoing subtotal

oesophagectomy for ACA:

1. Proportion of patients with ECLNI

2. Cancer specific survival

1. 3 year survival and stage of disease

2. Cancer specific survival using the number of nodes involved with extracapsular spread

Methods• Prospective database

• Subtotal Oesophagectomy for ACA

• January 2006 to January 2013 (n=363)

• Node positive disease

• TNM 7th edition

• SPSS version 19

Results

Total numbern = 363

Node positive diseasen=180

ECLNIn = 100

Node negative diseasen=183

ICLNIn = 80

27.5% with ECLNI

Patient data and outcome

ICLNI

n=80

ECLNI

n=100

p

value

Age (years) 65 65 0.973

M:F 3.2:1 10.1:1 0.012

Neo-adjuvant chemo 31.7% 43.3% 0.104

R0 resection 98.8% 94% 1.000

BMI 26.9 25.9 0.077

Blood transfusion 7.5% 5% 0.452

Operation time (mins) 357 360 0.621

Blood loss (mls) 530 590 0.585

Critical care stay (days) 2 2 0.784

Length of hospital stay (days) 19 17 0.333

Morbidity 64% 58% 0.447

Mortality 1.3% 2% 1.000

HistologyICLNI

n=80

ECLNI

n=100

p

value

Stage of disease 2b

3a

3b

3c

30%

38%

21%

11%

7%

23%

20%

50%

0.001

Venous involvement 44% 60% 0.036

Perineural involvement 50% 78% 0.001

Tumour differentiation

Well differentiated

Moderately differentiated

Poorly differentiated

9%

46%

45%

2%

45%

53%

1.000

Histology

ICLNI

n=80

ECLNI

n=100

p

value

Total number of nodes removed 34 34 0.483

Nodal status n1

n2

n3

56%

35%

9%

24%

27%

49%

0.001

Total number of positive nodes 2 6 0.001

Ratio of positive nodes:nodes removed

7% 18% 0.001

Survival

p<0.001

Median Survival (months)

ICLNI

n=80

ECLNI

n=100

p

value

Stage 2b

n=31

- 21.6 0.172

Stage 3a

n=53

36.6 32.6 0.590

Stage 3b

n=37

79.8 25.8 0.185

Stage 3c

n=59

21.8 15.5 0.347

Overall p<0.001

3 year Survival

ICLNI

n=80

ECLNI

n=100

p

value

Stage 2b 75% 43% 0.172

Stage 3a 60% 52% 0.590

Stage 3b 71% 45% 0.185

Stage 3c 33% 16% 0.347

Overall p<0.001

Survival

Overall Survival

(months)

95% CI

(months)

p

value

ICLNI 46.6 17.6 – 75.6

0.001

1 or 2 nodes with ECLNI 26.0 17.0 – 35.0

3 – 6 nodes with ECLNI 18.5 10.9 - 26.1

Over 7 nodes with ECLNI 16.5 11.0 – 22.0

Overall survival

p<0.001

Conclusion

Extracapsular lymph node involvement in node-positive patients with adenocarcinoma of the distal oesophagus or gastro-

oesophageal junction is a negative prognostic indicator and should be incorporated into the TNM classification