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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
Author(s) -
Mantziari Styliani,
Allemann Pierre,
Winiker Michael,
Sempoux Christine,
Demartines Nicolas,
Schäfer Markus
Publication year - 2017
Publication title -
journal of surgical oncology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.201
H-Index - 111
eISSN - 1096-9098
pISSN - 0022-4790
DOI - 10.1002/jso.24689
Subject(s) - medicine , surgery , esophageal cancer , lymph , neoadjuvant therapy , esophagectomy , lymph node , proportional hazards model , survival analysis , adjuvant , cancer , gastroenterology , oncology , pathology , breast cancer
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.