ORIGINAL ARTICLES

Isolated tumour cells in pathological node-negative lymph nodes adversely affect prognosis in cancer of the oesophagus or oesophagogastric junction

Martin J MacGuill¹, Ciara Barrett², Narayanasamy Ravi¹, George MacDonald² and John V Reynolds¹

¹ Department of Surgery, St James’s Hospital and Trinity College, Dublin, Ireland
² Department of Histopathology, St James’s Hospital and Trinity College, Dublin, Ireland

Correspondence to:
Professor John V Reynolds, Department of Clinical Surgery, Trinity Centre for Health Sciences, St James’s Hospital and Trinity College Dublin, Dublin 8, Ireland; reynoljv{at}tcd.ie

Aims: To determine the prevalence of isolated tumour cells (ITC) in lymph nodes of patients with pathological node-negative (pN0) tumours and to assess their impact on disease-free and overall survival.

Methods: Paraffin embedded lymph nodes from oesophagogastrectomy specimens were examined immunohistochemically using monoclonal anti-cytokeratin antibody (MNF118). Clinical and pathological features were summarised and overall and relapse-free survival were estimated.

Results: Isolated tumour cells were detected in 12 of 146 patients (8%), and 24 of 1694 (1%) lymph nodes. With a median follow-up time of 28 months (range 0–160 months), both relapse-free and overall survival were significantly (p<0.05) associated with the presence of ITC in pN0 lymph nodes. There was no significant difference in the prevalence of ITC between patients who underwent multimodal therapy and those treated with surgery alone.

Conclusions: ITC in pN0 lymph nodes may be less frequent than previously considered, but their presence is associated with poorer outcomes compared with true node negative disease.

Abbreviations: ITC, isolated tumour cells; pN0, pathological node-negative

Keywords: esophageal neoplasms; esophagogastric junction; neoplasm metastasis; lymphatic metastasis; immunochemistry

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