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Preoperative lymph node status on computed tomography influences the survival of pT1b, T2 and T3 esophageal squamous cell carcinoma

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Abstract

Purpose

The preoperative lymph node status is critical for tailoring optimal treatments for esophageal squamous cell carcinoma (ESCC). This study aimed to evaluate the prognostic impact of a diagnostic criterion based solely on the short-axis diameters of lymph nodes depicted on computed tomography (CT) in ESCC patients undergoing upfront esophagectomy.

Methods

We retrospectively reviewed 246 pT1b–T3 ESCC patients undergoing upfront esophagectomy. Clinically positive lymph node metastasis (cN+) was defined as nodes with a short-axis diameter of at least 8 mm on CT.

Results

Ninety-three patients had a cN+ status according to this criterion. The overall and recurrence-free survival rates were significantly lower in the cN+ group than in the cN− group (P < 0.001). The overall survival rate was markedly lower in the “pN2/3 and cN+” group than in the other groups (vs. pN0: P < 0.001, vs. pN1: P = 0.002, vs. “pN2/3 and cN−”: P < 0.001). However, the overall survival rate of the “pN2/3 and cN−” group was similar to that of the pN0–1 groups. A multivariate analysis showed that cN+ (P = 0.002), major complications (P = 0.001), and pT3 (P = 0.021) were independently associated with a poor prognosis.

Conclusion

A diagnostic criterion based solely on the short-axis diameters of lymph nodes depicted on CT was useful for stratifying the survival in ESCC patients.

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Abbreviations

ESCC:

Esophageal squamous cell carcinoma

CT:

Computed tomography

NACRT:

Neoadjuvant chemoradiotherapy

LN:

Lymph node

VATS:

Video-assisted thoracoscopic surgery

EGD:

Esophagogastroduodenoscopy

NAC:

Neoadjuvant chemotherapy

FDG-PET:

18F-fluorodeoxyglucose positron tomography

EUS:

Endoscopic ultrasonography

HR:

Hazard ratios

CI:

Confidence interval

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Authors and Affiliations

  1. Department of Gastrointestinal Surgery, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan

    Kotaro Sugawara, Hiroharu Yamashita, Koichi Yagi, Masato Nishida, Susumu Aikou, Sachiyo Nomura & Yasuyuki Seto

  2. Department of Bariatric and Metabolic Care, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan

    Susumu Aikou

  3. Biostatistics Division, Clinical Research Support Center, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan

    Yukari Uemura

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  1. Kotaro Sugawara
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  2. Hiroharu Yamashita
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Correspondence to Kotaro Sugawara.

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Sugawara, K., Yamashita, H., Uemura, Y. et al. Preoperative lymph node status on computed tomography influences the survival of pT1b, T2 and T3 esophageal squamous cell carcinoma. Surg Today 49, 378–386 (2019). https://doi.org/10.1007/s00595-018-1741-9

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  • DOI: https://doi.org/10.1007/s00595-018-1741-9

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