Lymph Node and Bone Marrow Micrometastases Define the Prognosis of Patients with pN0 Esophageal Cancer
Background: 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...
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MDPI AG
2020-03-01
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| Series: | Cancers |
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| Online Access: | https://www.mdpi.com/2072-6694/12/3/588 |
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| author | Karl-F. Karstens Tarik Ghadban Katharina Effenberger Guido Sauter Klaus Pantel Jakob R. Izbicki Yogesh Vashist Alexandra König Matthias Reeh |
| author_facet | Karl-F. Karstens Tarik Ghadban Katharina Effenberger Guido Sauter Klaus Pantel Jakob R. Izbicki Yogesh Vashist Alexandra König Matthias Reeh |
| author_sort | Karl-F. Karstens |
| collection | DOAJ |
| description | Background: 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. Methods: 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. Results: 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 (<i>p</i> = 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. Conclusions: 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. |
| first_indexed | 2024-03-12T09:59:29Z |
| format | Article |
| id | doaj.art-90225e6cff9c4d5280aae1851e8701b1 |
| institution | Directory Open Access Journal |
| issn | 2072-6694 |
| language | English |
| last_indexed | 2024-03-12T09:59:29Z |
| publishDate | 2020-03-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Cancers |
| spelling | doaj.art-90225e6cff9c4d5280aae1851e8701b12023-09-02T11:53:36ZengMDPI AGCancers2072-66942020-03-0112358810.3390/cancers12030588cancers12030588Lymph Node and Bone Marrow Micrometastases Define the Prognosis of Patients with pN0 Esophageal CancerKarl-F. Karstens0Tarik Ghadban1Katharina Effenberger2Guido Sauter3Klaus Pantel4Jakob R. Izbicki5Yogesh Vashist6Alexandra König7Matthias Reeh8Department of General, Visceral and Thoracic Surgery, University Medical Centre, Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, GermanyDepartment of General, Visceral and Thoracic Surgery, University Medical Centre, Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, GermanyDepartment of General, Visceral and Thoracic Surgery, University Medical Centre, Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, GermanyDepartment of Pathology, University Medical Centre, Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, GermanyDepartment of Tumor Biology, University Medical Centre, Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, GermanyDepartment of General, Visceral and Thoracic Surgery, University Medical Centre, Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, GermanyDepartment of General, Visceral and Thoracic Surgery, University Medical Centre, Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, GermanyDepartment of General, Visceral and Thoracic Surgery, University Medical Centre, Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, GermanyDepartment of General, Visceral and Thoracic Surgery, University Medical Centre, Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, GermanyBackground: 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. Methods: 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. Results: 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 (<i>p</i> = 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. Conclusions: 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.https://www.mdpi.com/2072-6694/12/3/588esophageal cancerstagingdisseminated tumor cellslymph node micrometastases |
| spellingShingle | Karl-F. Karstens Tarik Ghadban Katharina Effenberger Guido Sauter Klaus Pantel Jakob R. Izbicki Yogesh Vashist Alexandra König Matthias Reeh Lymph Node and Bone Marrow Micrometastases Define the Prognosis of Patients with pN0 Esophageal Cancer Cancers esophageal cancer staging disseminated tumor cells lymph node micrometastases |
| title | Lymph Node and Bone Marrow Micrometastases Define the Prognosis of Patients with pN0 Esophageal Cancer |
| title_full | Lymph Node and Bone Marrow Micrometastases Define the Prognosis of Patients with pN0 Esophageal Cancer |
| title_fullStr | Lymph Node and Bone Marrow Micrometastases Define the Prognosis of Patients with pN0 Esophageal Cancer |
| title_full_unstemmed | Lymph Node and Bone Marrow Micrometastases Define the Prognosis of Patients with pN0 Esophageal Cancer |
| title_short | Lymph Node and Bone Marrow Micrometastases Define the Prognosis of Patients with pN0 Esophageal Cancer |
| title_sort | lymph node and bone marrow micrometastases define the prognosis of patients with pn0 esophageal cancer |
| topic | esophageal cancer staging disseminated tumor cells lymph node micrometastases |
| url | https://www.mdpi.com/2072-6694/12/3/588 |
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