Sterilization of tumor‐positive lymph nodes of esophageal cancer by neo‐adjuvant treatment is associated with worse survival compared to tumor‐negative lymph nodes treated with surgery first. Issue 4 (25th May 2017)

• Record Type: Journal Article
• Authors: Mantziari, Styliani; Allemann, Pierre; Winiker, Michael; Sempoux, Christine; Demartines, Nicolas; Schäfer, Markus
• Is Part Of: Journal of surgical oncology. Volume 116:Issue 4(2017)
• Page Start: 524
• Page End: 532
• Publication Date: 2017-05-25
• Subjects: downstaging -- esophageal cancer -- esophagectomY -- lymph node metastasis -- neoadjuvant treatment; Cancer -- Surgery -- Periodicals; Neoplasms -- Periodicals; 616
• DOI: 10.1002/jso.24689
• Languages: English
• ISSNs: 0022-4790

Abstract

Abstract : Background and Objectives: Lymph node (LN) involvement by esophageal cancer is associated with compromised long‐term prognosis. This study assessed whether LN downstaging by neoadjuvant treatment (NAT) might offer a survival benefit compared to patients with a priori negative LN. Methods: Patients undergoing esophagectomy for cancer between 2005 and 2014 were screened for inclusion. Group 1 included cN0 patients confirmed as pN0 who were treated with surgery first, whereas group 2 included patients initially cN+ and down‐staged to ypN0 after NAT. Survival analysis was performed with the Kaplan‐Meier and Cox regression methods. Results: Fifty‐seven patients were included in our study, 24 in group 1 and 33 in group 2. Group 2 patients had more locally advanced lesions compared to a priori negative patients, and despite complete LN sterilization by NAT they still had worse long‐term survival. Overall 3‐year survival was 86.8% for a priori LN negative versus 63.3% for downstaged patients ( P = 0.013), while disease‐free survival was 79.6% and 57.9%, respectively ( P = 0.021). Tumor recurrence was also earlier and more disseminated for the down‐staged group. Conclusions: Downstaged LN, despite the systemic effect of NAT, still inherit an increased risk for early tumor recurrence and worse long‐term survival compared to a priori negative LN.