Zhi-Gang Li1, Xiao-Bin Zhang1, Yu-Wen Wen2,3, Yun-Hen Liu2, Yin-Kai Chao4. 1. Division of Thoracic Surgery, Shanghai Chest Hospital, Shanghai, China. 2. Division of Thoracic Surgery, Chang Gung Memorial Hospital-Linkou, College of Medicine, Chang Gung University, Taoyuan, Taiwan. 3. Clinical Informatics and Medical Statistics Research Center, Chang Gung University, Taoyuan, Taiwan. 4. Division of Thoracic Surgery, Chang Gung Memorial Hospital-Linkou, College of Medicine, Chang Gung University, Taoyuan, Taiwan. chaoyk@cgmh.org.tw.
Abstract
BACKGROUND: Radical lymph node (LN) dissection along the recurrent laryngeal nerve (RLN) area carries a substantial morbidity rate, and its usefulness in neoadjuvant chemoradiotherapy (nCRT)-treated esophageal cancer patients remains unclear. METHODS: This study was conducted in two Asian thoracic surgery centers. Patients with esophageal squamous cell carcinoma (ESCC) who were judged to be ycN-RLN(-) after nCRT and received bilateral RLN LN dissection were eligible. The incidence of unsuspected RLN LN involvement was analyzed, and we used least absolute shrinkage and selection operator (LASSO) regression to identify its predictors. RESULTS: A total of 56 patients (53 males and 3 females; mean age: 55 years) were included. The upper mediastinum-including the bilateral RLN area-was covered by the radiation field in 48 (85.3%) patients. Although all of them were judged as ycN-RLN(-), unsuspected RLN LN involvement was identified on pathological examination in 11 (19.6%) subjects, being the only positive nodal station in seven. LASSO regression identified the pre-nCRT RLN LN(cN-RLN) status as the only independent predictor of ypN-RLN positivity; in contrast, neither the tumor location nor the radiation dose to the upper mediastinum were independently associated with ypN-RLN(+). RLN nodal dissection resulted in positive LN discovery rates of 30.8 and 10% in ycN-RLN(-) patients who had positive and negative cN-RLNs before nCRT, respectively. Consequently, 23.1 and 6.7% of patients in each subgroup would have been understaged in the absence of RLN nodal dissection. CONCLUSION: Nearly one-fifth of ESCC patients who were judged to be ycN-RLN(-) unexpectedly had positive ypN-RLN. The pre-nCRT cN-RLN status plays a key role in the selection of patients that should undergo RLN LN dissection after nCRT.
BACKGROUND: Radical lymph node (LN) dissection along the recurrent laryngeal nerve (RLN) area carries a substantial morbidity rate, and its usefulness in neoadjuvant chemoradiotherapy (nCRT)-treated esophageal cancerpatients remains unclear. METHODS: This study was conducted in two Asian thoracic surgery centers. Patients with esophageal squamous cell carcinoma (ESCC) who were judged to be ycN-RLN(-) after nCRT and received bilateral RLN LN dissection were eligible. The incidence of unsuspected RLN LN involvement was analyzed, and we used least absolute shrinkage and selection operator (LASSO) regression to identify its predictors. RESULTS: A total of 56 patients (53 males and 3 females; mean age: 55 years) were included. The upper mediastinum-including the bilateral RLN area-was covered by the radiation field in 48 (85.3%) patients. Although all of them were judged as ycN-RLN(-), unsuspected RLN LN involvement was identified on pathological examination in 11 (19.6%) subjects, being the only positive nodal station in seven. LASSO regression identified the pre-nCRT RLN LN(cN-RLN) status as the only independent predictor of ypN-RLN positivity; in contrast, neither the tumor location nor the radiation dose to the upper mediastinum were independently associated with ypN-RLN(+). RLN nodal dissection resulted in positive LN discovery rates of 30.8 and 10% in ycN-RLN(-) patients who had positive and negative cN-RLNs before nCRT, respectively. Consequently, 23.1 and 6.7% of patients in each subgroup would have been understaged in the absence of RLN nodal dissection. CONCLUSION: Nearly one-fifth of ESCC patients who were judged to be ycN-RLN(-) unexpectedly had positive ypN-RLN. The pre-nCRT cN-RLN status plays a key role in the selection of patients that should undergo RLN LN dissection after nCRT.
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