Prognostic value of nodal micrometastases in patients with cancer of the gastro-oesophageal junction

Aims. Aim of this study was to examine the presence and the prognostic impact of immunohistochemically identified nodal micrometastases in patients with astro-oesophageal junction (GEJ) carcinomas.

Methods. Between January 1988 and December 2000, 148 patients underwent a radical (R0) resection with a two-field lymphadenectonny for a GEJ carcinoma. Specimens of 60 patients in whom conventional haematoxytin and eosin (H Et E) examination did not demonstrate lymph-node metastases (pN0) were available for immunohistochemical. (IHC) analysis using antibodies AE1/AE3 directed against cytokeratins. Paraffin embedded material of all. retrieved lymph nodes in these patients were seriatly sectioned and analysed by one pathologist after H Et E examination for the presence of micrometastases by IHC.

Results. In 60 resection specimens initially staged as pN0 a total of 524 lymph nodes were available for IHC analyses. Micrometastases were detected in 126 out of 524 lymph nodes (24%), corresponding with 18 of the 60 patients (30%) who were upstaged by this technique. Compared with the pN0 group, the disease free survival (DFS) was significantly tower in patients with nodal involvement at IHC (p <0.001). Survival of patients with IHC identified micrometastatic disease was comparable to those with H Et E positive lymph nodes.

Conclusions. Micrometastases in regional nodes were detected by cytokeratinspecific IHC in 30% of radical resected GEJ tumours; without overt nodal involvement. Their presence conveys a worse prognosis with a significant reduced DFS, suggesting that the finding of micrometastases should be included in the staging system. (c) 2004 Etsevier Ltd. Alt rights reserved.