Appraisal of a revised lymph node classification system for esophageal squamous cell cancer.

BACKGROUND: Node-positive patients with esophageal carcinoma constitute a heterogeneous population with a variable prognosis, which the current staging system insufficiently addresses. To that end, 863 patients with a curative resection for esophageal squamous cell carcinoma were analyzed to evaluate a useful and simple nodal classification system. METHODS: Along with standard conventional clinicopathologic factors, data for metastatic lymph node (MLN) number, metastatic to examined LN ratio (MLN ratio), and MLN size were evaluated. The greatest microscopic dimension of the metastatic tumor inside the largest MLN (MLN size) was measured on histopathologic slides. Patients with MLNs were classified into n1 (< 9 mm) and n2 (> or = 9 mm) groups, according to size of MLNs (n-stage). RESULTS: The paratracheal LNs most frequently contained the largest MLN and among them the right recurrent laryngeal LNs were the most common site (81.8%). Patients were stratified into significant groups by all the nodal criteria. In multivariable analysis, MLN size n-stage and MLN ratio N-stage were the best independent predictors for disease-free and overall survival, respectively. In the disease-free survival, MLN ratio N-stage subcategories were divided into prognostic groups according to the n-stage. A combined nodal staging strategy combining the n-stage and N-stage had the strongest prognostic value and was used for the tumor-node-metastasis classification with distinct separation of patients into prognostic groups. CONCLUSIONS: Results of this study indicate that the MLN size may serve as an accurate metric to classify node-positive patients and a combination of the MLN ratio and size may have synergism in classifying node-positive patients into prognostically homogenous groups.

Prognosis of patients with gastric carcinoma treated in remote island hospitals in Japan: a multivariable analysis.

BACKGROUND: Treating gastric cancer in remote island hospitals remains a major clinical challenge. Factors affecting prognosis of patients treated in general hospitals are still at large. We sought to determine the characteristics of gastric cancer in the Amamiooshima (Amami) archipelago of Japan and also evaluated the independent prognostic factors by the Cox regression analysis. MATERIALS AND METHODS: A total of 125 patients treated in four sister hospitals in the Amami were analyzed. RESULTS: The median age of patients with resection was 74 years and almost 85% patients had diffuse type of cancer. The 5-year overall survival was 34% for all patients and 58% for those who had a resection. Among the several clinicopathological factors, operation method (distal vs. total gastrectomy), splenectomy, lymphatic and venous invasion, T-stage, metastatic lymph node (MLN) size n-stage and UICC N-stage had significant impact on survival. Only MLN size and intraoperative blood loss had independent effect on survival by multivariable analysis. CONCLUSION: Improved perioperative care may yield a reasonable patient survival in elderly patients with gastric carcinoma treated in remote hospitals. Restricting amount of intraoperative blood loss may further improve the patient prognosis and MLN size may serve as a new metric to stage gastric cancers.