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Clinical Impact of the Location of Lymph Node Metastases After Neoadjuvant Chemotherapy for Middle and Lower Thoracic Esophageal Cancer

  • Gastrointestinal Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

In the current cancer staging systems, the location of lymph node (LN) metastases is not considered, although LN status is defined according to the number of LN metastases.

Objectives

This study aimed to investigate the clinical impact of the location of LN metastases in esophageal cancer and to evaluate the relevance of minimizing the extent of lymphadenectomy after neoadjuvant therapy.

Methods

In 561 patients with esophageal cancer who underwent neoadjuvant chemotherapy, the therapeutic value of each LN dissection was estimated by multiplying the incidence of metastasis by the 5-year survival rate of patients with positive nodes. In addition, we examined whether the value was affected by the response to neoadjuvant therapy.

Results

Metastasis to the celiac LN and middle mediastinal LN regions was identified as an independent prognostic factor by multivariate analysis, together with the number of LN metastases; however metastasis to the cervical LN and upper mediastinal LN regions was not identified as an independent prognostic factor. The therapeutic value was high in recurrent nerve LNs, paraesophageal LNs, paracardial LNs, and left gastric LNs. The therapeutic value for each LN dissection did not change according to the response to neoadjuvant therapy, excluding the lower mediastinal LN and perigastric LN stations for which the value was relatively high in patients with a poor response.

Conclusion

The present study shows that the location and number of LN metastases have a prognostic impact in patients with esophageal cancer undergoing neoadjuvant chemotherapy. Limited lymphadenectomy according to the response to neoadjuvant therapy cannot be justified.

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Author information

Authors and Affiliations

  1. Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan

    Hiroshi Miyata MD, Makoto Yamasaki MD, Tomoki Makino MD, Koji Tanaka MD, Masaki Mori MD & Yuichiro Doki MD

  2. Department of Pathology, Graduate School of Medicine, Osaka University, Osaka, Japan

    Eiichi Morii MD

  3. Department of Digestive Surgery, Osaka International Cancer Institute, Osaka, Japan

    Hiroshi Miyata MD, Keijirou Sugimura MD, Takeshi Omori MD, Kazuyoshi Yamamoto MD, Yoshitomo Yanagimoto MD & Masahiko Yano MD

  4. Department of Pathology, Osaka International Cancer Institute, Osaka, Japan

    Shinichi Nakatsuka MD

Authors
  1. Hiroshi Miyata MD
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  2. Keijirou Sugimura MD
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  3. Makoto Yamasaki MD
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  4. Tomoki Makino MD
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  13. Yuichiro Doki MD
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Corresponding author

Correspondence to Hiroshi Miyata MD.

Electronic supplementary material

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Fig. 1

Map of each lymph node, defined by the Japanese classification and AJCC cancer staging systems. Each letter represents a lymph node listed in Table 1. Upper: Japanese classification; lower: AJCC cancer staging (TIFF 2980 kb)

Fig. 2

Overall survival rate in 561 patients with esophageal cancer who underwent neoadjuvant chemotherapy followed by surgery, according to the number of metastatic lymph nodes (TIFF 2310 kb)

Fig. 3

Overall survival rate in 561 patients according to the response to neoadjuvant chemotherapy (TIFF 2398 kb)

Supplementary material 4 (DOCX 34 kb)

Appendices

Surgical Treatment

Surgical resection was performed 3–6 weeks after the completion of chemotherapy. Standard procedures for middle and lower thoracic esophageal cancer in this series consisted of transthoracic esophagectomy with cervical lymphadenectomy, mediastinal lymphadenectomy, upper abdominal lymphadenectomy, reconstruction of the gastric tube, and anastomosis of the cervical incision. Cervical lymphadenectomy was sometimes omitted based on pretreatment diagnosis of LN metastases and the intraoperative genetic and pathological diagnosis of LN metastasis along the recurrent laryngeal nerves.19 Pretracheal LNs and LNs around the abdominal aorta were dissected only when those LNs seemed to be metastatic at the initial diagnosis.

Statistical Analysis

Data are expressed as the mean ± standard deviation. Overall survival was calculated from the date of commencement of neoadjuvant therapy to the occurrence of the event or the last known date of follow-up. Actual survival was calculated using the Kaplan–Meier method, and statistically evaluated using the log-rank test. The Cox proportional hazards regression model was used to analyze the simultaneous influence of various prognostic factors. A p value < 0.05 denoted the presence of statistical significance. These analyses were carried out using JMP version 9.0 software (SAS institute, Cary, NC, USA).

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Miyata, H., Sugimura, K., Yamasaki, M. et al. Clinical Impact of the Location of Lymph Node Metastases After Neoadjuvant Chemotherapy for Middle and Lower Thoracic Esophageal Cancer. Ann Surg Oncol 26, 200–208 (2019). https://doi.org/10.1245/s10434-018-6946-z

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  • DOI: https://doi.org/10.1245/s10434-018-6946-z

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