Hui-Ju Ho1,2, Hui-Shan Chen3,4, Wei-Heng Hung1, Po-Kuei Hsu5, Shiao-Chi Wu4, Heng-Chung Chen1, Bing-Yen Wang6,7,8,9,10,11. 1. Division of Thoracic Surgery, Department of Surgery, Changhua Christian Hospital, No. 135 Nanxiao St., Changhua City, Changhua County, 500, Taiwan. 2. Division of Thoracic Surgery, Department of Surgery, E-Da Hospital, Kaohsiung, Taiwan. 3. Department of Health Care Administration, Chang Jung Christian University, Tainan, Taiwan. 4. Institute of Health and Welfare Policy, National Yang-Ming University, Taipei, Taiwan. 5. Division of Thoracic Surgery, Department of Surgery, Taipei Veterans General Hospital, National Yang-Ming University School of Medicine, Taipei, Taiwan. 6. Division of Thoracic Surgery, Department of Surgery, Changhua Christian Hospital, No. 135 Nanxiao St., Changhua City, Changhua County, 500, Taiwan. 156283@cch.org.tw. 7. School of Medicine, Chung Shan Medical University, Taichung, Taiwan. 156283@cch.org.tw. 8. School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan. 156283@cch.org.tw. 9. Institute of Genomics and Bioinformatics, National Chung Hsing University, Taichung, Taiwan. 156283@cch.org.tw. 10. Center for General Education, MingDao University, Changhua, Taiwan. 156283@cch.org.tw. 11. Ph.D. Program in Translational Medicine, National Chung Hsing University, Taichung, Taiwan. 156283@cch.org.tw.
Abstract
BACKGROUND: Current esophageal treatment guidelines suggest that, when more than 15 lymph nodes are detected, dissection should be done as the minimum requirement for staging in esophageal squamous cell carcinoma (ESCC) patients undergoing esophagectomy without induction chemoradiotherapy (CRT). However, for neoadjuvant CRT, there is limited information. We sought to clarify the role of lymphadenectomy in ESCC patients with and without neoadjuvant CRT. PATIENTS AND METHODS: Data on 3156 ESCC patients receiving esophagectomy with (group 1, n = 1399) and without (group 2, n = 1757) neoadjuvant CRT between 2008 and 2014 were collected from a national cancer registry in Taiwan. The impact of the resected lymph nodes on overall survival was assessed according to pathologic stages. A Cox regression model was used to identify prognostic factors for overall survival. RESULTS: Five-year overall survival rates were 35.6% for the entire group, 30.32% for group 1, and 39.55% for group 2 (p < 0.0001 for group 1 vs group 2). The best cutoff value was 21 lymph nodes in both group 1 and group 2. In group 1, the independent prognostic factors included age ≥ 54 years, clinical N status, y-pathologic T, y-pathologic N, y-pathologic stage, grade, location, margin status, esophagectomy (thoracoscopic vs open), and number of total resected lymph nodes (≤ 21 vs > 21). For group 2, the independent prognostic factors were gender, clinical stage, pathologic T, pathologic N, tumor length, grade, and margin status. CONCLUSIONS: Extent of lymphadenectomy was associated with survival in patients with neoadjuvant CRT followed by esophagectomy. The optimum lymphadenectomy should be modulated by pathologic stage.
BACKGROUND: Current esophageal treatment guidelines suggest that, when more than 15 lymph nodes are detected, dissection should be done as the minimum requirement for staging in esophageal squamous cell carcinoma (ESCC) patients undergoing esophagectomy without induction chemoradiotherapy (CRT). However, for neoadjuvant CRT, there is limited information. We sought to clarify the role of lymphadenectomy in ESCC patients with and without neoadjuvant CRT. PATIENTS AND METHODS: Data on 3156 ESCC patients receiving esophagectomy with (group 1, n = 1399) and without (group 2, n = 1757) neoadjuvant CRT between 2008 and 2014 were collected from a national cancer registry in Taiwan. The impact of the resected lymph nodes on overall survival was assessed according to pathologic stages. A Cox regression model was used to identify prognostic factors for overall survival. RESULTS: Five-year overall survival rates were 35.6% for the entire group, 30.32% for group 1, and 39.55% for group 2 (p < 0.0001 for group 1 vs group 2). The best cutoff value was 21 lymph nodes in both group 1 and group 2. In group 1, the independent prognostic factors included age ≥ 54 years, clinical N status, y-pathologic T, y-pathologic N, y-pathologic stage, grade, location, margin status, esophagectomy (thoracoscopic vs open), and number of total resected lymph nodes (≤ 21 vs > 21). For group 2, the independent prognostic factors were gender, clinical stage, pathologic T, pathologic N, tumor length, grade, and margin status. CONCLUSIONS: Extent of lymphadenectomy was associated with survival in patients with neoadjuvant CRT followed by esophagectomy. The optimum lymphadenectomy should be modulated by pathologic stage.
Authors: Leonie R van der Werf; Elske Marra; Suzanne S Gisbertz; Bas P L Wijnhoven; Mark I van Berge Henegouwen Journal: Ann Surg Oncol Date: 2020-10-16 Impact factor: 5.344
Authors: Apostolos Kandilis; Carlos Bravo Iniguez; Hassan Khalil; Emanuele Mazzola; Michael T Jaklitsch; Scott J Swanson; Raphael Bueno; Jon O Wee Journal: JTCVS Open Date: 2020-12-13