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Accuracy of preoperative diagnosis of lymph node metastasis for thoracic esophageal cancer patients from JCOG9907 trial

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Abstract

Background

Accurate clinical evaluation of lymph nodes is crucial for selection of the optimum treatment strategy for individual esophageal cancer patients. This study investigated the accuracy of preoperative clinical diagnosis of lymph node metastasis for patients with clinical stage II/III esophageal squamous cell carcinoma.

Methods

Patients assigned to receive surgery and postoperative chemotherapy in JCOG9907 trial were studied to evaluate the concordance between clinical and pathological nodes. Preoperative diagnosis was based on computed tomography or magnetic resonance imaging.

Results

Among 166 patients in the postoperative group, 160 with sufficient pathological data were studied. The patient background characteristics were: male/female, 147/13; median age, 61 years (range 39–75 years); primary tumor site (upper/middle/lower), 15/76/69; cN0/cN1, 53/107. The sensitivity and specificity of clinical nodes for diagnosis of pathological nodes were 72.7 and 51.3 %, respectively; the positive and negative predictive values were 82.2 and 37.7 %, respectively. The lymph nodes overestimated in the preoperative diagnosis included thoracic paratracheal lymph nodes (#106) (n = 8), middle thoracic paraesophageal lymph nodes (#108) (n = 4), lymph nodes along the lesser curvature (#3) (n = 4), right cardiac lymph nodes (#1) (n = 3), and left cardiac lymph nodes (#2) (n = 2).

Conclusion

Diagnosis of clinical nodes has low specificity and low negative predictive value for prediction of pathological node category in the preoperative diagnosis of lymph node metastasis for patients with locally advanced resectable esophageal cancer. Clinical staging techniques must therefore be improved for accurate preoperative diagnosis.

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Acknowledgments

The authors are grateful to the members of the JCOG Data Center and the JCOG Operations Office for their support in preparing the manuscript, statistical analysis, data management, and study management. JCOG9907 was supported in part by Grants-in-Aid for Cancer Research (14S-3, 14S-4, 17S-3, 17S-5, 20S-3, and 20S-6) from the Ministry of Health, Labour, and Welfare of Japan, and the National Cancer Center Research and Development Fund (23-A-16, 23-A-21, and 26-A-4) of Japan.

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Authors and Affiliations

  1. Division of Gastrointestinal Oncology, Shizuoka Cancer Center, 1007 Shimonagakubo, Nagaizumi-cho, Sunto-gun, Shizuoka, 411-8777, Japan

    Tomoya Yokota

  2. Esophageal Surgery Division, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan

    Hiroyasu Igaki

  3. Gastrointestinal Oncology Division, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan

    Ken Kato

  4. Division of Esophageal Surgery, Shizuoka Cancer Center, 1007 Shimonagakubo, Nagaizumi-cho, Sunto-gun, Shizuoka, 411-8777, Japan

    Yasuhiro Tsubosa

  5. Japan Clinical Oncology Group Data Center/Operations Office, Center for Research Administration and Support, National Cancer Center, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan

    Junki Mizusawa, Hiroshi Katayama, Kenichi Nakamura & Haruhiko Fukuda

  6. Department of Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-0016, Japan

    Yuko Kitagawa

Authors
  1. Tomoya Yokota
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  2. Hiroyasu Igaki
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  3. Ken Kato
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  4. Yasuhiro Tsubosa
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  5. Junki Mizusawa
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  6. Hiroshi Katayama
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  7. Kenichi Nakamura
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  8. Haruhiko Fukuda
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  9. Yuko Kitagawa
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Corresponding author

Correspondence to Tomoya Yokota.

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Conflict of interest

Dr. Yuko Kitagawa has received honoraria from Nippon Kayaku Co., Ltd and Kyowa Hakko Kirin Co., Ltd. Dr. Yuko Kitagawa has received research funding from Nippon Kayaku Co., Ltd, Kyowa Hakko Kirin Co., Ltd, Bristol–Myers Squibb, and Pfizer Co., Ltd.

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Yokota, T., Igaki, H., Kato, K. et al. Accuracy of preoperative diagnosis of lymph node metastasis for thoracic esophageal cancer patients from JCOG9907 trial. Int J Clin Oncol 21, 283–288 (2016). https://doi.org/10.1007/s10147-015-0899-z

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  • DOI: https://doi.org/10.1007/s10147-015-0899-z

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