Lymph Node Harvest in Esophageal Cancer After Neoadjuvant Chemoradiotherapy

• Published in: Annals of surgical oncology Vol. 20; no. 9; pp. 3038 - 3043
• Main Authors: Shridhar, Ravi, Hoffe, Sarah E., Almhanna, Khaldoun, Weber, Jill M., Chuong, Michael D., Karl, Richard C., Meredith, Kenneth
• Format: Journal Article
• Language: English
• Published: Boston Springer US 01-09-2013; Springer Nature B.V
• Subjects: Adenocarcinoma - mortality; Adenocarcinoma - pathology; Adenocarcinoma - therapy; Adult; Aged; Aged, 80 and over; Antineoplastic Combined Chemotherapy Protocols - therapeutic use; Carcinoma, Squamous Cell - mortality; Carcinoma, Squamous Cell - pathology; Carcinoma, Squamous Cell - therapy; Chemoradiotherapy - mortality; Cisplatin - administration & dosage; Combined Modality Therapy; Esophageal Neoplasms - mortality; Esophageal Neoplasms - pathology; Esophageal Neoplasms - therapy; Esophagectomy; Female; Fluorouracil - administration & dosage; Follow-Up Studies; Humans; Lymph Node Excision - mortality; Lymph Nodes - pathology; Lymph Nodes - surgery; Lymphatic Metastasis; Male; Medicine; Medicine & Public Health; Middle Aged; Multivariate Analysis; Neoadjuvant Therapy - mortality; Neoplasm Staging; Oncology; Organoplatinum Compounds - administration & dosage; Paclitaxel - administration & dosage; Prognosis; Surgery; Surgical Oncology; Survival Rate; Thoracic Oncology; Esophageal Cancer; Lymph Node; Pathologic Response; Overall Survival; Intensity Modulate Radiation Therapy
• DOI: 10.1245/s10434-013-2988-4
• EISSN: 1534-4681
• ISSN: 1068-9265

Background
This study was designed to determine the effects of lymph node (LN) harvest on survival in esophageal cancer after neoadjuvant chemoradiation (nCRT).
Methods
An analysis of surgically resected esophageal cancer patients after nCRT was performed to determine an association between the number of LNs resected and survival. Overall survival (OS) and disease-free survival (DFS) curves were calculated according to the Kaplan–Meier method and log-rank analysis. Multivariate analysis (MVA) was performed by the Cox proportional hazard model.
Results
We identified 358 patients with a mean follow-up of 27.3 months. The number of LN removed was not impacted by the type of surgical procedure. The number of LNs removed (<10 vs. ≥10, <12 vs. ≥12, and <15 vs. ≥15) did not impact OS or DFS. We found a significant difference in OS and DFS by pathologic response. The median and 5-year OS for patients with complete, partial, and no response was 65.6 months and 52.7 %, 29.7 months and 30.4 %, and 17.7 months and 25.4 % (
p
 = 0.0002). However, the number of LN harvested did not impact OS and DFS when patients were stratified by pathologic response. MVA also revealed that the number of lymph nodes removed was not prognostic for OS or DFS. Higher age, higher stage, and less than a complete response were associated with a decreased OS. Higher stage and less than a complete response were prognostic for worse DFS.
Conclusions
The number of LNs harvested during esophagectomy does not impact survival after nCRT. Stage and pathologic response continue to be the strongest prognostic factors for survival in esophageal cancer after nCRT.