Metastatic lymph node ratio, 6th or 7th AJCC edition: witch is the best lymph node classification for esophageal cancer? Prognosis factor analysis in 487 patients

BACKGROUND: The esophageal cancer is one of the most common and aggressive worldwide. Recently, the AJCC changed the staging system, considering, among others, the important role of the lymph node metastasis on the prognosis. AIM: To discuss the applicability of different forms of lymph node staging in a western surgical center. METHODS: Four hundred eighty seven patients with esophageal cancer were enrolled. Three staging systems were evaluated, the 6(th) and the 7(th) AJCC editions and the Lymph Node Metastatic Ratio. RESULTS: The majority of the cases were squamous cell carcinoma. The mean lymph node sample was eight. Considering the survival, there was no significant difference between the patients when they were classified by the 7(th) AJCC edition. Analysis of the Lymph Node Metastatic Ratio, just on the group of patients with 0 to 25%, has shown significant difference (p=0,01). The 6(th) AJCC edition shows the major significant difference between among the classifications evaluated. CONCLUSION: In this specific population, the 7(th) AJCC edition for esophageal cancer was not able to find differences in survival when just the lymph node analysis was considered.