Prognostic Relevance of Lymph Node Regression After Neoadjuvant Chemoradiation for Esophageal Cancer

Philippron, Annouck; Bollschweiler, Elfriede; Kunikata, Ayumi; Plum, Patrick Sven; Schmidt, Claudia; Favi, Francesco; Drebber, Uta; Hölscher, A. H.

doi:10.1053/j.semtcvs.2016.04.003

Cited by 35 publications

(34 citation statements)

References 27 publications

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“…Of note, these pathologic regression systems should include not only regression grading for the primary tumour but also for the lymph nodes. Indeed, for oesophageal and cardia cancer [18][19][20][21][22][23][24] the prognostic relevance of nodal response to preoperative treatments has already been demonstrated, and this is likely to be significant in gastric cancer, too.…”

Section: Statementmentioning

confidence: 99%

Consensus on the pathological definition and classification of poorly cohesive gastric carcinoma

et al. 2018

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Section: Statementmentioning

confidence: 99%

Consensus on the pathological definition and classification of poorly cohesive gastric carcinoma

et al. 2018

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“…A previous study evaluated lymph node regression following neoadjuvant chemoradiotherapy in a mixed cohort of 403 patients with oesophageal adenocarcinoma and squamous cell carcinoma. A significant survival benefit was demonstrated for patients exhibiting signs of lymph node response to treatment, a finding supported by the present results.…”

Section: Discussionmentioning

confidence: 99%

Lymph node regression and survival following neoadjuvant chemotherapy in oesophageal adenocarcinoma

Davies

Myoteri²,

Zylstra

et al. 2018

British Journal of Surgery

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“…Additionally, anatomical location of the nodes was not recorded in most cases. This latter aspect is probably important, as recently published studies suggest that treatment response in lymph nodes and anatomical location of lymph nodes with residual disease may be more relevant than primary tumour TRG when predicting patient prognosis . Primary analyses also included a small proportion of patients (CS n = 26, S n = 22), derived from a single centre, who were subjected to pre‐operative radiotherapy according to local practice.…”

Section: Discussionmentioning

confidence: 99%

“…This latter aspect is probably important, as recently published studies suggest that treatment response in lymph nodes and anatomical location of lymph nodes with residual disease may be more relevant than primary tumour TRG when predicting patient prognosis. [23][24][25] Primary analyses also included a small proportion of patients (CS n = 26, S n = 22), derived from a single centre, who were subjected to pre-operative radiotherapy according to local practice. We performed exploratory subgroup analyses excluding these patients, demonstrating the retention of the prognostic effects observed in the entire cohort, some with enhanced prognostic effects ( Figures S2-S5).…”

Section: Discussionmentioning

confidence: 99%

Prognostic value of pathological lymph node status and primary tumour regression grading following neoadjuvant chemotherapy – results from the MRC OE02 oesophageal cancer trial

et al. 2018

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AimsNeoadjuvant chemotherapy (NAC) remains an important therapeutic option for advanced oesophageal cancer (OC). Pathological tumour regression grade (TRG) may offer additional information by directing adjuvant treatment and/or follow‐up but its clinical value remains unclear. We analysed the prognostic value of TRG and associated pathological factors in OC patients enrolled in the Medical Research Council (MRC) OE02 trial.Methods and resultsHistopathology was reviewed in 497 resections from OE02 trial participants randomised to surgery (S group; n = 244) or NAC followed by surgery [chemotherapy plus surgery (CS) group; n = 253]. The association between TRG groups [responders (TRG1–3) versus non‐responders (TRG4–5)], pathological lymph node (LN) status and overall survival (OS) was analysed. One hundred and ninety‐five of 253 (77%) CS patients were classified as ‘non‐responders’, with a significantly higher mortality risk compared to responders [hazard ratio (HR) = 1.53, 95% confidence interval (CI) = 1.05–2.24, P = 0.026]. OS was significantly better in patients without LN metastases irrespective of TRG [non‐responders HR = 1.87, 95% CI = 1.33–2.63, P < 0.001 versus responders HR = 2.21, 95% CI = 1.11–4.10, P = 0.024]. In multivariate analyses, LN status was the only independent factor predictive of OS in CS patients (HR = 1.93, 95% CI = 1.42–2.62, P < 0.001). Exploratory subgroup analyses excluding radiotherapy‐exposed patients (n = 48) showed similar prognostic outcomes.ConclusionLymph node status post‐NAC is the most important prognostic factor in patients with resectable oesophageal cancer, irrespective of TRG. Potential clinical implications, e.g. adjuvant treatment or intensified follow‐up, reinforce the importance of LN dissection for staging and prognostication.

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Prognostic Relevance of Lymph Node Regression After Neoadjuvant Chemoradiation for Esophageal Cancer

Cited by 35 publications

References 27 publications

Consensus on the pathological definition and classification of poorly cohesive gastric carcinoma

Consensus on the pathological definition and classification of poorly cohesive gastric carcinoma

Lymph node regression and survival following neoadjuvant chemotherapy in oesophageal adenocarcinoma

Prognostic value of pathological lymph node status and primary tumour regression grading following neoadjuvant chemotherapy – results from the MRC OE02 oesophageal cancer trial

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