Association of IGF1R overexpression (OE) with outcome in invasive urothelial carcinoma (UC) of urinary bladder.

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. 4523-4523
Author(s):  
Nilda Gonzalez-Ribbon ◽  
Jenny J. Kim ◽  
Alcides Chaux ◽  
Enrico Munari ◽  
Shiela F. Faraj ◽  
...  
Keyword(s):  
Proportional Hazards ◽  
Muscularis Propria ◽  
Cox Proportional Hazards ◽  
Tyrosine Kinase Receptor ◽  
Disease Specific Survival ◽  
Medical Systems ◽  
Scoring Method ◽  
Significant Independent Predictor ◽  
Clinicopathologic Parameters ◽  
Disease Specific

4523 Background: Insulin-like growth factor-1 receptor (IGF1R) is a transmembrane tyrosine kinase receptor involved in cell proliferation and differentiation. IGF1R is overexpressed in several tumors including UC and is currently under investigation as a target of Rx. We here explore IGF1R expression in UC, its association with clinicopathologic parameters and prognostic role. Methods: Fivetissue microarrays (TMA) were constructed from 100 cystectomy specimens performed for invasive UC at our institution (1994 to 2007). Formalin-fixed paraffin-embedded paired tumor and benign samples were spotted 3-4 times each. Membranous IGF1R staining was evaluated using immunohistochemistry (G11, Ventana Medical Systems). A scoring method analogous to that of Her2 expression in breast cancer was used and the highest score was assigned to each tumor. IGF1R was considered overexpressed in cases with score 1. Endpoints of the study included overall survival (OS) and disease-specific survival (DSS). Patients were followed-up for a median of 33.5 months (range 1, 141 months). Results: IGF1R OE was found in 62% of UC. No differences were noted between normal urothelium and UC regarding IGF1R OE (74% vs. 60%; P=0.14). IGFR1 OE was more frequent in tumors from African-American patients compared to Caucasians (100% vs. 59%, P=0.04). Tumors at stage pT4 overexpressed IGF1R more frequently than tumors at stages pT1-pT3 (71% vs. 29%, P=0.005). No association with other analyzed clinicopathologic parameters such as patient's age or gender, muscularis propria invasion, or lymph node metastasis) was found. OS and disease-specific survival (DSS) rates were 58% and 69%, respectively. Patients with tumors overexpressing IGF1R had a lower OS and DSS compared to those without IGF1R OE (Mantel-Cox P=0.0007 and P=0.006, respectively). Using Cox proportional hazards regression, IGF1R OE remained a significant predictor of OS (HR=3.49, P=0.001) and DSS (HR=3.54, P=0.007) after adjusting for pathologic stage. Conclusions: OE of IGF1R was found in 62% of UC. High stage tumors overexpressed IGF1R more frequently than low stage tumors. Further, IGF1R OE was a significant independent predictor of OS and DSS in invasive UC.

Overexpression of IGF1R to predict outcome in invasive urothelial carcinoma of urinary bladder.

2013 ◽  
Vol 31 (6_suppl) ◽  
pp. 280-280
Author(s):  
Jenny J. Kim ◽  
Nilda Gonzalez-Roibon ◽  
Alcides Chaux ◽  
Enrico Munari ◽  
Shiela F. Faraj ◽  
...  
Keyword(s):  
Overall Survival ◽  
Urothelial Carcinoma ◽  
Proportional Hazards ◽  
Muscularis Propria ◽  
Cox Proportional Hazards ◽  
Tyrosine Kinase Receptor ◽  
Scoring Method ◽  
Significant Independent Predictor ◽  
Cancer Specific Survival ◽  
Clinicopathologic Parameters

280 Background: Insulin-like growth factor-1 receptor (IGF1R) is a transmembrane tyrosine kinase receptor involved in cell proliferation and differentiation. IGF1R is overexpressed (OE) in several tumors including bladder cancer and is currently under investigation as a target of Rx. Here we explore IGF1R expression in urothelial carcinoma (UC), its association with clinicopathologic parameters and prognostic role. Methods: Fivetissue microarrays (TMA) were constructed from 100 cystectomy specimens performed for invasive UC at our institution (1994 to 2007). Formalin-fixed paraffin-embedded paired tumor and benign samples were spotted 3-4 times each. Membranous IGF1R staining was evaluated using immunohistochemistry (G11, Ventana Medical Systems). A scoring method analogous to that of Her2 expression in breast cancer was used and the highest score was assigned to each tumor. IGF1R was considered OE in cases with score 1. Endpoints of the study included overall survival and cancer-specific survival. Patients were followed-up for a median of 33.5 months (range 1, 141 months). Results: IGF1R was OE in 62% of UC. No differences were noted between normal urothelium and malignant counterparts (74% vs. 60%; P=0.14). IGFR1 was more frequently OE in tumors from African-American patients compared to Caucasians (100% vs. 59%, P=0.04). pT4 tumors OE IGF1R more frequently than pT1-pT3 tumors (71% vs. 29%, P=0.005). No association was found with other analyzed clinicopathologic parameters such as patient's age or gender, muscularis propria invasion, or lymph node metastasis). Overall survival (OS) and disease-specific survival (DSS) rates were 58% and 69%, respectively. Patients whose tumors OE IGF1R had a lower OS and DSS compared to those whose tumors did not OE IGF1R (Mantel-Cox P=0.0007 and P=0.006, respectively). Using Cox proportional hazards regression, IGF1R overexpression remained a significant predictor of OS (HR=3.49, P=0.001) and DSS (HR=3.54, P=0.007) after adjusting for pathologic stage. Conclusions: Overexpression of IGF1R was found in 62% of UC. High stage tumors OE IGF1R more frequently than low stage tumors. More importantly, IGF1R overexpression was a significant independent predictor of OS and DSS.

Comparison of survival rates in carcinoma in situ of the breast treated with total mastectomy to breast-conserving surgery and radiotherapy

2007 ◽  
Vol 25 (18_suppl) ◽  
pp. 519-519 ◽  
Author(s):  
M. N. Ibrahim ◽  
Z. Abdullah ◽  
L. Healy ◽  
C. Murphy ◽  
I. Y. Yousif ◽  
...  
Keyword(s):  
Overall Survival ◽  
Proportional Hazards ◽  
Survival Rates ◽  
Breast Conserving Surgery ◽  
Cox Proportional Hazards ◽  
Disease Specific Survival ◽  
Total Mastectomy ◽  
Kaplan Meier ◽  
Disease Specific

519 Background: Carcinoma in situ (CIS) of the breast is a precancerous lesion with the potential to progress to invasive cancer. In 2003, CIS accounted for 19% of all newly diagnosed invasive and non-invasive breast lesions combined in the United States. Current treatment options are mastectomy ± tamoxifen, and breast-conserving surgery with radiotherapy ± tamoxifen. As there are no randomized comparisons of these 2 treatments, data from the Surveillance Epidemiology and End Results (SEER) database was used to compare their survival rates. Methods: 88,285 patients were identified with CIS from 1988 - 2003. Of these, 27,728 patients were treated with a total mastectomy, and 25,240 patients received breast-conserving surgery with radiotherapy. Kaplan-Meier survival analyses and Cox proportional hazards regression were used to compare overall survival and disease specific survival at 5 and 10 years. Results: Kaplan-Meier analyses demonstrated 5 year overall survival rates for total mastectomy vs. breast conserving surgery with radiotherapy of 95.46% vs. 97.59% respectively (Log-rank P < 0.0001). The 5 year rates for disease specific survival were 99.16% vs. 99.72% respectively (Log-rank P < 0.0001). At 10 years the overall survival rates had fallen to 91.96% vs. 96.09% respectively (Log-rank P < 0.0001). The 10 year disease specific survival rates were 98.61% vs. 99.50% respectively (Log-rank P < 0.0001). Cox proportional hazards regression demonstrated a relative risk of 0.847 (95% confidence interval (CI) 0.790 - 0.907) and 1.110 (95% CI 0.931 - 1.324) for 5 year overall survival and disease specific survival respectively, when total mastectomy was compared with breast conserving surgery and radiotherapy. At 10 years, the relative risks were 0.865 (95% CI 0.820 - 0.913) and 1.035 (95% CI 0.900 - 1.190) for overall survival and disease specific survival respectively. Conclusions: Overall, when looking at disease-specific survival rates by multi-variate analysis, there does not appear to be a significant difference between total mastectomy and breast-conserving surgery with radiotherapy in the treatment of CIS. No significant financial relationships to disclose.

The role of surgical staging in grade 1 endometrioid corpus cancer

2006 ◽  
Vol 24 (18_suppl) ◽  
pp. 5009-5009
Author(s):  
J. K. Chan ◽  
H. Guo ◽  
M. K. Cheung ◽  
K. Osann ◽  
A. Husain ◽  
...  
Keyword(s):  
Proportional Hazards ◽  
Uterine Cancer ◽  
Stage Iv ◽  
Distant Metastases ◽  
Cox Proportional Hazards ◽  
Surgical Staging ◽  
Disease Specific Survival ◽  
Grade 3 ◽  
Disease Specific

5009 Background: To evaluate the role of surgical staging of patients with grade 1 endometrioid uterine cancer. Methods: Data including stage, histology, grade, lymph nodes involvement and disease-specific survival were extracted from Surveillance, Epidemiology, and End Results Program from 1988 to 2001. Kaplan-Meier and Cox proportional hazards analyses were used to determine the predictors for survival. Results: 12,712 women were diagnosed with endometrioid carcinoma which included 3,867 (30.4%) with grade 1, 5,285 (41.6%) with grade 2, and 3,560 (28%) with grade 3 disease. The 5-year disease specific survival of patients with grade 1, 2, and 3 disease was 97.78% ± 0.29, 92.14% ± 0.45, and 78.04% ± 0.82, respectively. Of all the patients with nodal involvement, 10% had grade 1, 39% had grade 2 and 51% had grade 3 disease (p < 0.001). Positive nodes were found in 3% of grade 1, 9% of grade 2 and 18% in grade 3 tumors (p < 0.001). Of the 3,867 patients with grade 1 disease, 3,281 (84.9%) had stage I, 317 (8.2%) had stage II, 166 (4.3%) had stage III, and 103 (2.7%) had stage IV disease. Fifteen percent of the patients with grade 1 disease had extra-uterine spread, including 8% to the cervix, 4% to the pelvis and 3% to the upper abdomen or distant metastases. Conclusions: Grade 1 uterine cancers have a risk of extra-uterine spread. Given that the information obtained from a thorough staging procedure clearly influences adjuvant treatment decisions, complete surgical staging is recommended. No significant financial relationships to disclose.

scholarly journals The Impact of Insurance and Marital Status on Survival in Patients with Nasopharyngeal Carcinoma

Biology ◽  
2020 ◽  
Vol 9 (4) ◽  
pp. 84
Author(s):  
Chih-Chun Wang ◽  
Ching-Chieh Yang ◽  
Shyh-An Yeh ◽  
Chung-I Huang ◽  
Tzer-Zen Hwang ◽  
...  
Keyword(s):  
Nasopharyngeal Carcinoma ◽  
Marital Status ◽  
Proportional Hazards ◽  
Survival Rates ◽  
Cox Proportional Hazards ◽  
Disease Specific Survival ◽  
Uninsured Patients ◽  
The Impact ◽  
To Receive ◽  
Disease Specific

Objective: This study aimed to explore the influence of social support on the survival outcomes of patients with nasopharyngeal carcinoma (NPC). We examined whether the combined proxy influenced whether patients were more likely to receive radiotherapy. Methodology: data were collected from the 18 registries of the National Cancer Institute’s Surveillance, Epidemiology, and End Results database. The association between both insurance status and marital status and disease-specific survival rates were evaluated with a multivariate Cox proportional-hazards regression model to calculate the hazard ratios and associated confidence intervals. Odds ratio (OR) computed by logistic regression was also used to examine the relationship between the receipt of radiotherapy and insurance and marital status. Results: insured and uninsured patients differed significantly in T-stage, N-stage, M-stage, radiotherapy use, race, and marital status. The uninsured-non-married patients showed the lowest 5-year disease-specific survival rates. We further found unmarried patients with either Medicaid (OR, 0.40), or no insurance (OR, 0.24) had lower odds of receiving radiotherapy than those with insurance at diagnosis. Conclusions: uninsured-unmarried NPC patients had a significantly higher risk of distant metastasis at diagnosis, poorer 5-year disease-specific survival, and were less likely to receive radiotherapy than insured-married patients.

Conditional and Overall Disease-Specific Survival in Patients With Paranasal Sinus and Nasal Cavity Cancer: Improved Outcomes in the Endoscopic Era

2021 ◽  
pp. 194589242110191
Author(s):  
Rahul K. Sharma ◽  
Alexandria L. Irace ◽  
Rodney J. Schlosser ◽  
Jonathan B. Overdevest ◽  
Nicholas R. Rowan ◽  
...  
Keyword(s):  
Nasal Cavity ◽  
Paranasal Sinus ◽  
Proportional Hazards ◽  
Cox Regression ◽  
Cox Proportional Hazards ◽  
Disease Specific Survival ◽  
Endoscopic Techniques ◽  
Before And After ◽  
Year 2000 ◽  
Disease Specific

Background The management of paranasal sinus and nasal cavity malignancies has evolved significantly with the development of advanced endoscopic techniques and improvements in adjuvant therapy. We sought to characterize both disease-specific survival (DSS) and 5-year conditional disease-specific survival (CDSS, the change in life expectancy with increasing survivorship) for sinus malignancies diagnosed before and after the year 2000. Methods Patients diagnosed with sinus and nasal cavity cancer between 1973-2015 were extracted from the Surveillance, Epidemiology, End Results (SEER) registry. Kaplan-Meier analysis for DSS was stratified by year of diagnosis before and after 2000. Cox-proportional hazards models of DSS controlling for stage, age, and year of diagnosis were generated. CDSS was calculated using Cox-regression models stratified by stage. Results We analyzed 10,535 patients. Diagnosis after the year 2000 was independently associated with improved DSS (HR:0.81, 95% CI: 0.75-0.87, P < .001) after controlling for age and stage. After stratifying by stage, diagnosis after year 2000 was associated with improved DSS for localized (HR:0.71, 0.59-0.86, P < .001) malignancies, regional (HR: 0.86, 0.78-0.94, P = .001) and distant malignancies (HR 0.74, 0.63-0.87, P < .001). CDSS improved with increasing survivorship for all stages of sinus and nasal cavity cancer, and those diagnosed after 2000 had improved CDSS compared to those diagnosed before 2000. Descriptively, the association of year of diagnosis with CDSS diminished with increasing survivorship for localized cancers, but was consistent for other stages. Conclusion For paranasal sinus and nasal cavity malignancies, year of diagnosis independently influences both DSS and CDSS. Improved survival is likely due to advances in both surgical and adjuvant treatments. To our knowledge, this study is the first to examine CDSS for these malignancies.

A nomogram predicting disease-specific survival after nephrectomy for papillary renal cell carcinoma

2009 ◽  
Vol 27 (15_suppl) ◽  
pp. 5091-5091
Author(s):  
T. Klatte ◽  
M. Remzi ◽  
J. W. Said ◽  
A. Haitel ◽  
F. F. Kabbinavar ◽  
...  
Keyword(s):  
Renal Cell Carcinoma ◽  
Cell Carcinoma ◽  
Renal Cell ◽  
Proportional Hazards ◽  
Papillary Renal Cell Carcinoma ◽  
Cox Proportional Hazards ◽  
Microvascular Invasion ◽  
Disease Specific Survival ◽  
Collecting System ◽  
Disease Specific

5091 Background: Whereas multiple nomograms have been developed to assess outcomes of patients with clear cell renal cell carcinoma, a model to assess prognosis of papillary renal cell carcinoma (PRCC) has not yet been developed. After data collection and slide review of a large cohort of patients, the aim of this study was to develop and to internally validate a nomogram for prediction of disease-specific survival for PRCC. Methods: Out of 2,687 patients who underwent surgery for a renal tumor between 1989 and 2008 at two institutions, 258 (10%) were found to have PRCC. H&E slides were reviewed by one uro-pathologist at each institution for papillary sub-type, tumor grade, microvascular invasion, sarcomatoid features, collecting system invasion and presence and extent of tumor necrosis. A nomogram was constructed as a graphical representation of significant variables of disease-specific survival in multivariate Cox proportional hazards regression analysis. The discrimination and calibration of the nomogram were assessed, both utilizing bootstrapping to obtain relatively unbiased estimates. Results: After a median follow-up of 35 months, 49 PRCC-related deaths (19%) had occurred. In univariate analysis, incidental detection, T, N, M stage, grade, microvascular invasion, collecting system invasion, papillary sub-type, sarcomatoid features, and necrosis were all associated with prognosis. Multivariate Cox proportional hazards analysis, however, identified incidental detection, T stage, M stage, microvascular invasion, and necrosis, but not papillary sub-type as independent prognostic factors of disease-specific survival. These variables formed the basis of the nomogram that predicted 5-year disease-specific survival probability. The nomogram predicted well, with a bootstrapped corrected concordance index of 0.93, and showed good calibration. Conclusions: A highly accurate tool utilizing basic clinical and pathological information for predicting disease-specific survival was developed specifically for PRCC. This tool should be helpful for identification of the subset of PRCC patients with aggressive clinical behavior, and may contribute to the ability to individualize postoperative surveillance and therapy. No significant financial relationships to disclose.

Comparison of survival outcomes in medullary carcinoma and invasive ductal carcinoma of the breast

2019 ◽  
Vol 15 (27) ◽  
pp. 3111-3123
Author(s):  
Siying Chen ◽  
Yang Liu ◽  
Jin Yang ◽  
Qingqing Liu ◽  
Haisheng You ◽  
...  
Keyword(s):  
Invasive Ductal Carcinoma ◽  
Proportional Hazards ◽  
Ductal Carcinoma ◽  
Medullary Carcinoma ◽  
Clinicopathological Characteristics ◽  
Cox Proportional Hazards ◽  
Disease Specific Survival ◽  
Propensity Score Matching Analysis ◽  
Cox Proportional Hazards Models ◽  
Disease Specific

Aim: To compare clinicopathological characteristics and prognoses of medullary carcinoma (MC) and invasive ductal carcinoma (IDC) of the breast. Patients & methods: We screened patients from the SEER database. Kaplan–Meier analysis and Cox proportional hazards models were used to investigate influence on survival. Propensity score matching analysis was performed to reduce possible bias. Results: Compared with IDC, MC tended to be younger patients, poor differentiation, negative estrogen receptor and progesterone receptor and chemotherapy. Better overall survival and disease-specific survival were observed in MC patients than in IDC patients. It shared several prognostic factors. Worse disease-specific survival was observed in IDC patients than in MC patients (HR: 1.590; 95% CI: 1.475–1.714; p < 0.001). Conclusion: The clinical features and outcomes had evident differences between MC and IDC patients. These findings will provide more information for the prognosis of MC and IDC.

Acute myeloid leukemia (AML) in older women after adjuvant breast cancer therapy

2006 ◽  
Vol 24 (18_suppl) ◽  
pp. 560-560 ◽  
Author(s):  
D. A. Patt ◽  
Z. Duan ◽  
G. Hortobagyi ◽  
S. H. Giordano
Keyword(s):  
Breast Cancer ◽  
Adjuvant Chemotherapy ◽  
Older Women ◽  
Proportional Hazards ◽  
Cox Proportional Hazards ◽  
Significant Independent Predictor ◽  
Kaplan Meier ◽  
Cox Proportional Hazards Models ◽  
Adjuvant Breast Cancer ◽  
Comorbidity Scores

560 Background: Adjuvant chemotherapy for breast cancer is associated with the development of secondary AML, but this risk in an older population has not been previously quantified. Methods: We queried data from the Surveillance, Epidemiology, and End Results-Medicare (SEER-Medicare) database for women who were diagnosed with nonmetastatic breast cancer from 1992–1999. We compared the risk of AML in patients with and without adjuvant chemotherapy (C), and by differing C regimens. The primary endpoint was a claim with an inpatient or outpatient diagnosis of AML (ICD-09 codes 205–208). Risk of AML was estimated using the method of Kaplan-Meier. Cox proportional hazards models were used to determine factors independently associated with AML. Results: 36,904 patients were included in this observational study, 4,572 who had received adjuvant C and 32,332 who had not. The median patient age was 75.3 (66.0–103.3). The median follow up was 63 months (13–132). Patients who received C were significantly younger, had more advanced stage disease, and had lower comorbidity scores (p<0.001). The unadjusted risk of developing AML at 10 years after any adjuvant C for breast cancer was 1.6% versus 1.1% for women who had not received C. The adjusted HR for AML with adjuvant C was 1.72 (1.16–2.54) compared to women who did not receive C. HR for radiation was 1.21 (0.86–1.70). HR was higher with increasing age but p>0.05. An analysis was performed among women who received C. When compared to other C regimens, anthracycline-based therapy (A) conveyed a significantly higher hazard for AML HR 2.17 (1.08–4.38), while patients who received A plus taxanes (T) did not have a significant increase in risk HR1.29 (0.44–3.82) nor did patients who received T with some other C HR 1.50 (0.34–6.67). Another significant independent predictor of AML included GCSF use HR 2.21 (1.14–4.25). In addition, increasing A dose was associated with higher risk of AML (p<0.05). Conclusions: There is a small but real increase in AML after adjuvant chemotherapy for breast cancer in older women. The risk appears to be highest from A-based regimens, most of which also contained cyclophosphamide, and may be dose-dependent. T do not appear to increase risk. The role of GCSF should be further explored. No significant financial relationships to disclose.

Association between warfarin combined with serotonin-modulating antidepressants and increased case fatality in primary intracerebral hemorrhage: a population-based study

2014 ◽  
Vol 120 (6) ◽  
pp. 1358-1363 ◽  
Author(s):  
Pekka Löppönen ◽  
Sami Tetri ◽  
Seppo Juvela ◽  
Juha Huhtakangas ◽  
Pertti Saloheimo ◽  
...  
Keyword(s):  
Intracerebral Hemorrhage ◽  
Selective Serotonin Reuptake Inhibitors ◽  
Proportional Hazards ◽  
Oral Anticoagulants ◽  
Case Fatality ◽  
Population Based ◽  
Cox Proportional Hazards ◽  
Significant Independent Predictor ◽  
Kaplan Meier ◽  
Concurrent Use

Object Patients receiving oral anticoagulants run a higher risk of cerebral hemorrhage with a poor outcome. Serotonin-modulating antidepressants (selective serotonin reuptake inhibitors [SSRIs], serotonin-norepinephrine reuptake inhibitors [SNRIs]) are frequently used in combination with warfarin, but it is unclear whether this combination of drugs influences outcome after primary intracerebral hemorrhage (PICH). The authors investigated case fatality in PICH among patients from a defined population who were receiving warfarin alone, with aspirin, or with serotonin-modulating antidepressants. Methods Nine hundred eighty-two subjects with PICH were derived from the population of Northern Ostrobothnia, Finland, for the years 1993–2008, and those with warfarin-associated PICH were eligible for analysis. Their hospital records were reviewed, and medication data were obtained from the national register of prescribed medicines. Kaplan-Meier survival curves were drawn to illustrate cumulative case fatality, and a Cox proportional-hazards analysis was performed to demonstrate predictors of death. Results Of the 176 patients eligible for analysis, 17 had been taking aspirin and 19 had been taking SSRI/SNRI together with warfarin. The 30-day case fatality rates were 50.7%, 58.8%, and 78.9%, respectively, for those taking warfarin alone, with aspirin, or with SSRI/SNRI (p = 0.033, warfarin plus SSRI/SNRI compared with warfarin alone). Warfarin combined with SSRI/SNRI was a significant independent predictor of case fatality (adjusted HR 2.10, 95% CI 1.13–3.92, p = 0.019). Conclusions Concurrent use of warfarin and a serotonin-modulating antidepressant, relative to warfarin alone, seemed to increase the case fatality rate for PICH. This finding should be taken into account if hematoma evacuation is planned.

Lymph Node Ratio is a Significant Predictor of Disease-Specific Mortality in Patients Undergoing Esophagectomy for Cancer

2012 ◽  
Vol 78 (5) ◽  
pp. 528-534 ◽  
Author(s):  
Matthew Fox ◽  
Russell Farmer ◽  
Charles R. Scoggins ◽  
Kelly M. McMasters ◽  
Robert C. G. Martin
Keyword(s):  
Lymph Node ◽  
Proportional Hazards ◽  
Current System ◽  
Staging System ◽  
Cancer Staging ◽  
Cox Proportional Hazards ◽  
Lymph Node Yield ◽  
Kaplan Meier ◽  
Esophagectomy For Cancer ◽  
Disease Specific

The seventh edition of the American Joint Committee on Cancer esophageal cancer staging system classifies nodal status by the number of malignant nodes (LNMs) found. This may be confounded by variations in lymphadenectomy and specimen review. The ratio of lymph nodes containing metastases to the total nodes excised (LNR) has been suggested as an alternative. We seek to validate the use of LNR for staging and determine the effect of the total lymph node yield (LNY) on its accuracy. A review of our prospective esophageal database identified 94 patients who underwent esophagectomy for cancer at out institution from 1992 until 2010. Univariate and multi-variate analyses were performed. The mean age of our patients was 59.4 years. Transthoracic esophagectomy was performed in all but three instances. The majority of tumors were adenocarcinoma, 76 per cent. Overall survival at 2 and 5 years was 52 and 29 per cent, respectively. LNY correlated with LNM ( r = 0.302, P = 0.001) but not LNR ( r = 0.012, P = 0.912). Using Kaplan-Meier analysis, LNR had no effect on disease-specific (DS) survival ( P = 0.803). However, a Cox proportional hazards regression model showed LNR to be a significant predictor of DS mortality (hazard ratio, 9.47; P = 0.049). The lack of correlation between LNR and LNY suggests that LNR may be a more robust staging method when LNY is low. Furthermore, LNR was found to be a significant predictor of DS mortality when controlling for other factors influencing survival. However, neither a staging system based on LNR nor its efficacy compared with the current system could be determined from these data.

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