Hosch S B, Stoecklein N H, Pichlmeier U, Rehders A, Scheunemann P, Niendorf A, Knoefel W T, Izbicki J R
Department of Surgery, University of Hamburg, Germany.
J Clin Oncol. 2001 Apr 1;19(7):1970-5. doi: 10.1200/JCO.2001.19.7.1970.
Data on skip metastases and their significance are lacking for esophageal cancer. This issue is important to determine the extent of lymphadenectomy for esophageal resection. In this study we examined the lymphatic spread in esophageal cancer by routine histopathology and by immunohistochemistry.
A total of 1,584 resected lymph nodes were obtained from 86 patients with resected esophageal carcinoma and evaluated by routine histopathology. Additionally, frozen tissue sections of 540 lymph nodes classified as tumor-free by routine histopathology were screened for micrometastases by immunohistochemistry with the monoclonal antibody Ber-EP4. The lymph nodes were mapped according to the mapping scheme of the American Thoracic Society modified by Casson et al.
Forty-four patients (51%) had pN1 disease, and 61 patients (71%) harbored lymphatic micrometastases detected by immunohistochemistry. Skip metastases detected by routine histopathology were present in 34% of pN1 patients. Skipping of micrometastases detected by immunohistochemistry was found in 66%. The presence of micrometastases was associated with a significantly decreased relapse-free and overall survival (56.0 v 10.0 months and > 64 v 15 months, P <.0001 and P =.004, respectively). Cox regression analysis revealed the independent prognostic influence of micrometastases in lymph nodes. Lymph node skipping had no significant independent prognostic influence on survival.
Histopathologically and immunohistochemically detectable skip metastases are a frequent event in esophageal cancer. Only extensive lymph node sampling, in conjunction with immunohistochemical evaluation, will lead to accurate staging. An improved staging system is essential for more individualized adjuvant therapy.
食管癌跳跃转移及其意义的数据尚缺乏。该问题对于确定食管癌切除术中淋巴结清扫范围很重要。在本研究中，我们通过常规组织病理学和免疫组织化学检查了食管癌的淋巴转移情况。
从86例接受食管癌切除术的患者中获取了总共1584个切除的淋巴结，并通过常规组织病理学进行评估。此外，对540个经常规组织病理学分类为无肿瘤的淋巴结冰冻组织切片，用单克隆抗体Ber-EP4进行免疫组织化学检查以筛查微转移。根据Casson等人修改的美国胸科学会的图谱方案对淋巴结进行定位。
44例患者（51%）有pN1疾病，61例患者（71%）存在免疫组织化学检测到的淋巴微转移。在pN1患者中，常规组织病理学检测到的跳跃转移占34%。免疫组织化学检测到的微转移跳跃占66%。微转移的存在与无复发生存期和总生存期显著降低相关（分别为56.0对10.0个月和>64对15个月，P<.0001和P=.004）。Cox回归分析显示淋巴结微转移具有独立的预后影响。淋巴结跳跃对生存无显著的独立预后影响。
组织病理学和免疫组织化学可检测到的跳跃转移在食管癌中很常见。只有广泛的淋巴结采样结合免疫组织化学评估，才能实现准确分期。改进的分期系统对于更个体化的辅助治疗至关重要。
