Higher lymph node harvest in patients with a pathologic complete response after neoadjuvant therapy for esophageal cancer is associated with improved survival

Abstract

Background and Objectives Lymph node harvest during esophagectomy has been associated with improved survival for esophageal cancer but the value of enhanced lymph node harvest following complete pathologic response (pCR) is debated. This study investigated if increasing lymph node harvest in esophageal cancer patients with a pCR after neoadjuvant therapy and esophagectomy is associated with improved survival. Methods We queried the National Cancer Data Base for patients with esophageal cancer between 2004 and 2014 who underwent neoadjuvant chemotherapy or chemoradiation therapy followed by esophagectomy found to have pCR. Multivariable Cox modeling was utilized to evaluate the impact of increasing lymph node counts on overall survival (OS). Results A total of 1373 patients met inclusion criteria. A National Comprehensive Cancer Network compliant lymphadenectomy of ≥15 nodes was associated with improved survival (66.7% vs 51.1%; P < .001). Cox modeling showed that the first node cutoff to demonstrate a statistically significant improvement in OS was ≥7 nodes (hazard ratio [HR], 95% confidence interval [CI]: 0.81, 0.68‐0.97; 5‐year OS: 54.2%) with a trend of decreasing and statistically significant HRs until ≥25 nodes (HR, 95% CI: 0.52, 0.37‐0.72; 5‐year OS: 68.4%). Conclusions High negative node counts after neoadjuvant therapy and esophagectomy are associated with improved survival in patients with pCR.

Recent advances in multidisciplinary therapy for adenocarcinoma of the esophagus and esophagogastric junction

“…Additionally, studies have shown that lymph node harvest during esophagectomy is associated with improved postoperative survival. A study by Lutfi et al [ 26 ] demonstrated that during lymphadenectomy, when 7 lymph nodes were harvested, OS improved significantly, and when 25 Lymph nodes were harvested, it showed maximum OS benefits. Other researchers also came to a similar conclusion regarding the influence of lymphadenectomy on postoperative survival after neoadjuvant therapy; when the number of lymph node dissections reached 25, postoperative life expectancy was the highest[ 27 ].…”

Reply: The Continued Debate on Robotic Segmentectomy—agree to Disagree

“…The extent of lymph node resection has been widely discussed in the field of esophageal surgery. [7][8][9] Its influence on long-term survival is also of great interest in lung cancer surgery.…”

The predictive value of peripheral blood cells and lymphocyte subsets in oesophageal squamous cell cancer patients with neoadjuvant chemoradiotherapy

“…Several clinical trials have demonstrated that neoadjuvant chemoradiotherapy can improve long-term survival and reduce locoregional cancer recurrence (4,5). Approximately 30% of oesophageal cancer patients will have a pathological complete response (pCR) after neoadjuvant chemoradiotherapy, and these patients will benefit more from neoadjuvant chemoradiotherapy (6)(7)(8). In recent years, the question has been raised of whether surgery can be dispensed with for patients who achieve pCR.…”