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Type: Journal article
Title: Isolated tumor cells in esophageal cancer: Implications for the surgeon and the pathologist
Author: Thompson, S.
Ruszkiewicz, A.
Jamieson, G.
Sullivan, T.
Devitt, P.
Citation: Annals of Surgery, 2010; 252(2):299-306
Publisher: Lippincott Williams & Wilkins
Issue Date: 2010
ISSN: 0003-4932
Statement of
Sarah K. Thompson, Andrew R. Ruszkiewicz, Glyn G. Jamieson, Thomas R. Sullivan and Peter G. Devitt
Abstract: Introduction: Studies suggest that up to 56% of node-negative patients have tumor deposits in their lymph nodes that are missed by routine pathologic examination. However, few studies differentiate between isolated tumor cells and micrometastases using reproducible criteria, and their prognostic significance has not been established. Methods: We identified 119 patients who had undergone surgical resection for esophageal cancer between 1997 and 2007, and who were classified as node-negative. Relevant paraffin blocks were identified, and 3 additional levels, each 250 µm apart, were cut of all lymph nodes. Isolated tumor cells and micrometastases were defined according to size criteria but additional data and characteristics were recorded. Two slides were made at each level (1 for hematoxylin and eosin, 1 for immunohistochemistry). Results were correlated with survival. Results: One patient was found to have a metastasis (>2 mm), 8 patients (7%) had micrometastases, and 22 patients (18%) had isolated tumor cells. The 5-year survival rates were 60% for patients who remained nodenegative, 33% for patients with isolated tumor cells, 40% for patients with micrometastases, and 0 for the patient with a metastasis (P=0.02). A significant difference was found between node-negative patients versus patients whose lymph nodes contained isolated tumor cells (P=0.014). Most tumor deposits (71%) were identified on the first additional section. Conclusions: Our results suggest that isolated tumor cells are as important as micrometastases in determining survival in patients with esophageal cancer. This has important implications in the retrieval and pathologic analysis of lymph nodes.
Keywords: Lymph Nodes; Humans; Esophageal Neoplasms; Lymphatic Metastasis; Neoplasm Staging; Immunoenzyme Techniques; Prognosis; Esophagectomy; Staining and Labeling; Registries; Survival Rate; Proportional Hazards Models; Statistics, Nonparametric; Middle Aged; Female; Male
Rights: Copyright © 2010 by Lippincott Williams & Wilkins
RMID: 0020100635
DOI: 10.1097/SLA.0b013e3181e61e15
Appears in Collections:Surgery publications

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