Sterilization of tumor-positive lymph nodes of esophageal cancer by neo-adjuvant treatment is associated with worse survival compared to tumor-negative lymph nodes treated with surgery first.

Details

Serval ID
serval:BIB_54805A049918
Type
Article: article from journal or magazin.
Collection
Publications
Institution
Title
Sterilization of tumor-positive lymph nodes of esophageal cancer by neo-adjuvant treatment is associated with worse survival compared to tumor-negative lymph nodes treated with surgery first.
Journal
Journal of surgical oncology
Author(s)
Mantziari S., Allemann P., Winiker M., Sempoux C., Demartines N., Schäfer M.
ISSN
1096-9098 (Electronic)
ISSN-L
0022-4790
Publication state
Published
Issued date
09/2017
Peer-reviewed
Oui
Volume
116
Number
4
Pages
524-532
Language
english
Notes
Publication types: Journal Article
Publication Status: ppublish
Abstract
Lymph node (LN) involvement by esophageal cancer is associated with compromised long-term prognosis. This study assessed whether LN downstaging by neoadjuvant treatment (NAT) might offer a survival benefit compared to patients with a priori negative LN.
Patients undergoing esophagectomy for cancer between 2005 and 2014 were screened for inclusion. Group 1 included cN0 patients confirmed as pN0 who were treated with surgery first, whereas group 2 included patients initially cN+ and down-staged to ypN0 after NAT. Survival analysis was performed with the Kaplan-Meier and Cox regression methods.
Fifty-seven patients were included in our study, 24 in group 1 and 33 in group 2. Group 2 patients had more locally advanced lesions compared to a priori negative patients, and despite complete LN sterilization by NAT they still had worse long-term survival. Overall 3-year survival was 86.8% for a priori LN negative versus 63.3% for downstaged patients (P = 0.013), while disease-free survival was 79.6% and 57.9%, respectively (P = 0.021). Tumor recurrence was also earlier and more disseminated for the down-staged group.
Downstaged LN, despite the systemic effect of NAT, still inherit an increased risk for early tumor recurrence and worse long-term survival compared to a priori negative LN.

Keywords
Aged, Chemotherapy, Adjuvant, Disease-Free Survival, Esophageal Neoplasms/mortality, Esophageal Neoplasms/pathology, Female, Humans, Lymph Nodes/drug effects, Lymph Nodes/pathology, Lymph Nodes/radiation effects, Lymphatic Metastasis, Male, Middle Aged, Neoadjuvant Therapy, Neoplasm Recurrence, Local, Neoplasm Staging, Radiotherapy, Adjuvant, downstaging, esophageal cancer, esophagectomY, lymph node metastasis, neoadjuvant treatment
Pubmed
Web of science
Create date
26/05/2017 14:05
Last modification date
20/08/2019 15:09
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