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Predictors of long-term survival after resection of esophageal carcinoma with nonregional nodal metastases
Annals of Thoracic Surgery, 07/01/09

Lee FC et al. - In a study to analyze factors predicting long-term survival in patients with esophageal carcinoma and celiac, cervical, or other nonregional nodal metastases, it apears that surgical resection for pts with esophageal cancer associated with nonregional nodal metastases results in 25% survival at 5 yrs. Squamous histology, earlier T status, and perioperative chemotherapy are independent positive predictors of long-term survival.

• A retrospective review was conducted of a prospective database over a 20-yr period to identify pts with resected esophageal carcinoma with nonregional lymph node metastases.
• Medical records were reviewed and risk factors were analyzed.

• 67 pts underwent esophagectomy for M1a or M1b disease.
• Esophagectomy was transthoracic in 62 pts and transhiatal in 5.
• Median number of lymph nodes harvested was 36.
• Sites of nodal metastases were the following: recurrent nodal chain in 42 pts, celiac in 20, both recurrent and celiac in 4, and paratracheal in 1.
• Median length of follow-up was 66 mos; 5-yr overall survival (OS) for the cohort was 25%; 5-yr OS was significantly higher with earlier T-status.
• 13 pts who had nonregional nodal metastases without involvement of regional nodes (pN0) had a significant improvement in 5-yr survival (67% vs 15%).
• Pts with squamous cell carcinomas had higher 5-yr survival vs those with adenocarcinomas (42% vs 14%).
• Pts treated with induction chemotherapy had prolonged 5-yr survival (41%) vs those treated with adjuvant chemotherapy (11%) or no therapy (20%).
• Multivariate analysis demonstrated that chemotherapy treatment, squamous cell type, and early T stage (pT1/T2) are significant positive predictors of survival.

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