2018
DOI: 10.21037/jtd.2018.04.136
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ypT0N+: the unusual patient with pathological complete tumor response but with residual lymph node disease after neoadjuvant chemoradiation for esophageal cancer, what’s up?

Abstract: ypT0N+ in EC patients following nCRT has a poor prognosis and behaves similar to ypT+N+. However, stratification by histology shows that this is especially true in ADC but seems determined by the number of involved lymph nodes.

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Cited by 18 publications
(9 citation statements)
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“…7 The median overall survival among patients without a pathological complete response is shorter than that among those with a pathological complete response, and outcomes are even worse in patients with lymph node-positive disease. [7][8][9][10][11] Adjuvant treatments to improve outcomes are clearly needed; however, none has proved to be effective. Instead, the standard of care after neoadjuvant chemoradiotherapy and surgery is surveillance.…”
mentioning
confidence: 99%
“…7 The median overall survival among patients without a pathological complete response is shorter than that among those with a pathological complete response, and outcomes are even worse in patients with lymph node-positive disease. [7][8][9][10][11] Adjuvant treatments to improve outcomes are clearly needed; however, none has proved to be effective. Instead, the standard of care after neoadjuvant chemoradiotherapy and surgery is surveillance.…”
mentioning
confidence: 99%
“…Additionally, the TRG was evaluated by centre-specific pathologists and only evaluated the regression grade of the primary tumour and not of the lymph nodes. As a consequence, persistent disease only at the nodal level was possible [32][33][34]. Since the lack of adequate TRG systems for nodes after preoperative treatment and the relatively low percentage of patients in our study with an ypT0Nþ, the current study focussed on the primary tumour.…”
Section: Discussionmentioning
confidence: 99%
“…4 Studies show that residual nodal disease in EC patients with otherwise no residual tumor (ypT0 N + ) portends a poor prognosis, and behaves similar to pathologic stage ypT + N + diseases. 52,53 Of note, the NCCN guidelines recommend that the regression grading system should also include the nodal status, owing to its impact on survival. 24,52 For example, the grade 0 of complete response is defined as no viable cancer cells, including LNs.…”
Section: Esophageal and Egj Carcinoma Resection Specimens Following Nmentioning
confidence: 99%
“…The CAP cancer protocol does not require a minimum number to be reported, 29 while the NCCN guidelines recommend evaluating at least 15 LNs in esophageal resections irrespective of any preoperative neoadjuvant therapy 4 . Studies show that residual nodal disease in EC patients with otherwise no residual tumor (ypT0 N + ) portends a poor prognosis, and behaves similar to pathologic stage ypT + N + diseases 52,53 . Of note, the NCCN guidelines recommend that the regression grading system should also include the nodal status, owing to its impact on survival 24,52 .…”
Section: Esophageal and Egj Carcinoma Resection Specimens Following Nmentioning
confidence: 99%