Hiroshi Miyata1,2, Keijirou Sugimura3, Makoto Yamasaki4, Tomoki Makino4, Koji Tanaka4, Eiichi Morii5, Takeshi Omori3, Kazuyoshi Yamamoto3, Yoshitomo Yanagimoto3, Masahiko Yano3, Shinichi Nakatsuka6, Masaki Mori4, Yuichiro Doki4. 1. Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan. hmiyata@gesurg.med.osaka-u.ac.jp. 2. Department of Digestive Surgery, Osaka International Cancer Institute, Osaka, Japan. hmiyata@gesurg.med.osaka-u.ac.jp. 3. Department of Digestive Surgery, Osaka International Cancer Institute, Osaka, Japan. 4. Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan. 5. Department of Pathology, Graduate School of Medicine, Osaka University, Osaka, Japan. 6. Department of Pathology, Osaka International Cancer Institute, Osaka, Japan.
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.
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.