Karstens Karl-F, Ghadban Tarik, Effenberger Katharina, Sauter Guido, Pantel Klaus, Izbicki Jakob R, Vashist Yogesh, König Alexandra, Reeh Matthias
Department of General, Visceral and Thoracic Surgery, University Medical Centre, Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Germany.
Department of Pathology, University Medical Centre, Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Germany.
Cancers (Basel). 2020 Mar 4;12(3):588. doi: 10.3390/cancers12030588.
Pathological routine lymph node staging is postulated to be the main oncological prognosticator in esophageal cancer (EC). However, micrometastases in lymph nodes (LNMM) and bone marrow (BNMM) are discussed as the key events in tumor recurrence. We assessed the prognostic significance of the LNMM/BNMM status in initially pN0 staged patients with curative esophagectomy.
From 110 patients bone marrow aspirates and lymph node tissues were analyzed. For LNMM detection immunohistochemistry was performed using the anticytokeratin antibody AE1/AE3. To detect micrometastases in the bone marrow a staining with the pan-keratin antibody A45-B/B3 was done. Results were correlated with clinicopathologic parameters as well as recurrence and death during follow-up time.
Thirty-eight (34.5%) patients showed LNMM, whereas in 54 (49.1%) patients BNMM could be detected. LNMM and BNMM positive patients showed a correlation to an increased pT category ( = 0.017). Univariate and multivariate analyses revealed that the LNMM/BNMM status and especially LNMM skipping the anatomical lymph node chain were significant independent predictors of overall survival and recurrence-free survival.
This study indicates that routine pathological staging of EC is insufficient. Micrometastases in lymph nodes and the bone marrow seem to be the main reason for tumor recurrence and they are a strong prognosticator following curative treatment of pN0 EC.
病理常规淋巴结分期被认为是食管癌（EC）主要的肿瘤学预后指标。然而，淋巴结微转移（LNMM）和骨髓微转移（BNMM）被视为肿瘤复发的关键因素。我们评估了LNMM/BNMM状态在初始pN0分期且接受根治性食管切除术患者中的预后意义。
对110例患者的骨髓穿刺物和淋巴结组织进行分析。采用抗细胞角蛋白抗体AE1/AE3进行免疫组织化学检测LNMM。使用泛角蛋白抗体A45-B/B3对骨髓进行染色以检测微转移。将结果与临床病理参数以及随访期间的复发和死亡情况进行关联分析。
38例（34.5%）患者出现LNMM，而54例（49.1%）患者可检测到BNMM。LNMM和BNMM阳性患者与pT分期增加相关（P = 0.017）。单因素和多因素分析显示，LNMM/BNMM状态，尤其是跨越解剖学淋巴结链的LNMM是总生存和无复发生存的显著独立预测因素。
本研究表明EC的常规病理分期并不充分。淋巴结和骨髓中的微转移似乎是肿瘤复发的主要原因，并且是pN0 EC根治性治疗后的有力预后指标。
