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Analysis of prognostic factors in patients with lymph node recurrence after radical esophagectomy: importance of locoregional therapy

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Abstract

Purpose

Lymph node (LN) recurrence is frequently encountered in esophageal cancer. The aim of this study was to determine the effects of various factors, including loco-regional treatment of LN-only recurrence, on the survival rate.

Methods

Among 941 patients who underwent curative resection for esophageal squamous cell carcinoma in 2003–2016, we retrospectively reviewed 117 patients (12.4%) who developed LN-only recurrence.

Results

One, 2, 3, and 4 or more metastatic LNs were found in 72, 22, 6, and 17 patients, respectively, after a median disease-free interval of 8.4 months (range 1.1–62.0). Among all cases, recurrence was out of the surgical field in 53 cases (45.3%). Recurrent LNs were controlled by loco-regional treatment in 29 (43.9%) and by chemotherapy alone in 3 patients (7.0%). The 3-year survival rates of patients who did and did not achieve local control were 53.2% and 5.2%, respectively. Univariate analysis showed significant relationships between post-recurrence survival rate and pStage I–II at initial surgery, no history of radiotherapy, recurrence in ≤ 2 LN, and loco-regional treatment of LN recurrence. Multivariate analysis identified recurrence in ≤ 2 LN (HR 0.3169, 95% CI 0.1023–0.5314, p = 0.0038) and loco-regional treatment (HR 0.1973, 95% CI 0.0075–0.3871, p = 0.0416) as the only two significant and independent prognostic factors of survival.

Conclusions

Recurrence limited to ≤ 2 LN and loco-regional treatment (chemoradiotheapy or surgery) for LN recurrence were associated with favorable survival of patients with history of radical esophagectomy followed by LN recurrence. Our results emphasize the importance of local control of LN recurrence regardless of location.

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Authors and Affiliations

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

    Koji Tanaka, Makoto Yamasaki, Tomoki Makino, Kotaro Yamashita, Takuro Saitoh, Tsuyoshi Takahashi, Yukinori Kurokawa, Kiyokazu Nakajima, Hidetoshi Eguchi & Yuichiro Doki

  2. Department of Surgery, Osaka General Medical Center, Osaka, Japan

    Masaaki Motoori

  3. Department of Surgery, Kindai University Faculty of Medicine, Osaka, Japan

    Yutaka Kimura

  4. Department of Central Laboratory and Surgical Pathology, National Hospital Organization Osaka National Hospital, Osaka, 540-0006, Japan

    Masayuki Mano

  5. Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan

    Masaki Mori

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  1. Koji Tanaka
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  2. Makoto Yamasaki
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  3. Tomoki Makino
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  4. Kotaro Yamashita
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  13. Hidetoshi Eguchi
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  14. Yuichiro Doki
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Correspondence to Koji Tanaka.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Tanaka, K., Yamasaki, M., Makino, T. et al. Analysis of prognostic factors in patients with lymph node recurrence after radical esophagectomy: importance of locoregional therapy. Esophagus 18, 195–202 (2021). https://doi.org/10.1007/s10388-020-00778-x

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  • DOI: https://doi.org/10.1007/s10388-020-00778-x

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