Prognostic Significance of positive lymph node regression grade to Neoadjuvant Chemoradiation for Esophageal Squamous Cell Carcinoma

Abstract

Background and Purpose To assess the relationship between metastatic lymph node (LN) responder status and recurrence-free survival (RFS) in patients undergoing neoadjuvant chemoradiotherapy (NCRT).Materials and Methods We retrospectively reviewed 304 patients with local advanced esophageal squamous cell carcinoma received NCRT followed by esophagectomy. For 112 patients with positive node, according to the proportion of residual viable tumor cells area within the whole tumor beds of all metastatic LNs, we classified LN-tumor regression grade (LN-TRG) into four categories: grade 1, 0%; 2, < 10%; 3, 10–50%; 4, > 50%. Patients with grade 1 LN-TRG of were considered LN responders, and those with grades 2–4, as LN nonresponders. Univariate and multivariate analyses of recurrence-free survival (RFS) were estimated by a Cox regression model, Kaplan-Meier curve, and log-rank test.Results The median follow-up time of a total of 112 patients was 29.6 months. 52 (46.4%) patients have experienced recurrence. In Cox univariate analysis, LN responder status, nerve invasion, and lymphovascular invasion significantly correlated with RFS. Multivariate analysis for RFS revealed that LN responder status (P < 0.05) was an independent prognostic factor. The 3-year RFS rates for patients with LN-TRG of 1 to 4 grades were 72.7%, 76.5%, 37.4%, and 28.5%, respectively, and the median RFS times were not reach, 43.56 months, 28.09 months, 22.77 months, respectively.Conclusions LN responder status is an independent prognostic factor for RFS in esophageal cancer patients who received NCRT.