Pre- and post-therapy nodal status equally affects survival of patients with oesophageal squamous cell carcinoma receiving preoperative chemoradiation

Abstract

Abstract. Patients with deeply invading (T3-T4) oesophageal cancers usually receive chemoradiotherapy with or without surgery. However, the prognostic significance of pre-therapy and post-therapy lymph node (LN) status remains unclear. We studied 195 patients who received chemoradiotherapy for deeply invading oesophageal cancers (T3-4, N0-1, M0). Of these, 105 patients underwent surgery while 90 were treated by chemoradiotherapy alone. Of the 105 surgically treated patients, overall survival was significantly better in cN0 patients than in cN1 (3-year survival rate, 65.3 vs. 25.8%, P=0.0014). This difference was similarly observed in 90 patients who received chemoradiotherapy alone. Patient survival differed significantly among patients with no positive LN, 1 positive LN and 2-4 positive LN (3-year survival rate, 57.1 vs. 40.5 vs. 17.6%, P<0.0001). However, there was no significant difference in survival between patients with 2-4 positive LN and ≥5 positive LN. Multivariate analysis identified pre-therapy LN status and the number of involved LNs as the most important independent prognostic factors prior to histopathological tumour regression. In conclusion, pretherapy LN status and the number of post-therapy involved LNs equally affect survival of patients who receive neoadjuvant chemoradiotherapy. Control of systemic metastasis is required, based on pre-and post-therapy LN status.

The number of pathologic lymph nodes involved is still a significant prognostic factor even after neoadjuvant chemoradiotherapy in esophageal squamous cell carcinoma

“…Our data showed that the significance of pathologic metastatic LNs can also be a significant risk factor to predict the patient survival. Although some similar studies in adenocarcinoma of the esophagus were performed 22, 23, there are still few reports that support our conclusion in ESCC 24. Furthermore, we showed that the appropriate cut‐off line is between 2 and 3 metastatic LNs, and that this cut‐off line is able to distinguish between good survivors and poor survivors, as the MST was 45.1 months in patients with two or fewer metastatic LNs and 11.0 months in patients with three and more metastatic LNs (Fig.…”

Early Recurrence and Cancer Death After Trimodal Therapy for Esophageal Squamous Cell Carcinoma

“…Therefore, the risk factors for early recurrence and death might somewhat differ among studies. Pathological LN metastasis is an important prognostic factor for esophageal cancer treated with NCRT followed by surgery (5,24,25). The present multivariate analysis selected ypN2/3 as the only significant independent risk factor for early recurrence and showed that it also tended to be a risk factor for early cancer death (p=0.06).…”

The significance of lymph node status as a prognostic factor for esophageal cancer

“…24 Miyata et al similarly concluded that the nodal status strongly affected survival in patients of SCC treated with neoadjuvant CRT (P < 0.0001). 25 Other reports have examined the correlation between recurrence patterns and LN status. Nakagawa et al showed a close relationship between the number of LN metastases and hematogenous recurrence.…”