Skip to main content

Advertisement

SpringerLink
Log in

Comparative Quantitative Lymph Node Assessment in Localized Esophageal Cancer Patients After R0 Resection With and Without Neoadjuvant Chemoradiation Therapy

  • Original Article
  • Published:
Journal of Gastrointestinal Surgery Aims and scope

Abstract

Introduction

The effects of neoadjuvant chemoradiation therapy on lymph node retrieval during esophagectomy for patients with esophageal cancer are unclear. The aim of this study was to quantify lymph node retrieval after R0 esophagectomy and to assess its impact on overall survival in induction therapy patients.

Methods

One hundred seventy-four consecutive patients underwent esophagectomy with or without induction therapy from 2008 to 2015 for esophageal cancer. Total lymph nodes, positive lymph nodes, and lymph node ratios were compared between two groups of patients: those treated with either upfront surgery or those treated with neoadjuvant chemoradiation therapy followed by surgery. Comparisons were made using Student’s t test. Overall survival was obtained and compared using Kaplan Meier survival curves.

Results

Total lymph node counts were less in the induction therapy group (p = 0.027), while positive lymph node counts and lymph node ratios did not differ between groups (p = 0.262 and p = 0.310, respectively). In the neoadjuvant chemoradiation followed by surgery group, overall survival was significantly shorter for patients who had any positive lymph nodes in the pathologic specimen (p = 0.0065).

Conclusions

Total lymph node counts were significantly lower in the induction therapy group, while positive lymph node counts and lymph node ratios did not differ from the upfront surgery group. Although overall survival was not different between groups, it was decreased within the induction therapy cohort among those who had any positive lymph nodes retrieved at surgery. This study confirms that unstratified gross lymph node counts do not substantially relate to prognosis in the heterogeneous population of locally advanced esophageal cancer patients who may or may not have had neoadjuvant chemoradiation.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Enzinger PC, Mayer RJ. Esophageal cancer. N Engl J Med. 2003;349(23):2241–2252. doi:10.1056/NEJMra035010.

    Article  CAS  PubMed  Google Scholar 

  2. van Hagen P, Hulshof MC, van Lanschot JJ, et al. Preoperative chemoradiotherapy for esophageal or junctional cancer. N Engl J Med. 2012;366(22):2074–2084. doi:10.1056/NEJMoa1112088.

    Article  PubMed  Google Scholar 

  3. Meredith KL, Weber JM, Turaga KK, et al. Pathologic response after neoadjuvant therapy is the major determinant of survival in patients with esophageal cancer. Ann Surg Oncol. 2010;17(4):1159–1167. doi:10.1245/s10434-009-0862-1.

    Article  PubMed  Google Scholar 

  4. Dittrick GW, Weber JM, Shridhar R, et al. Pathologic nonresponders after neoadjuvant chemoradiation for esophageal cancer demonstrate no survival benefit compared with patients treated with primary esophagectomy. Ann Surg Oncol. 2012;19(5):1678–1684. doi:10.1245/s10434-011-2078-4.

    Article  PubMed  Google Scholar 

  5. Koen Talsma A, Shapiro J, Looman CW, et al. Lymph node retrieval during esophagectomy with and without neoadjuvant chemoradiotherapy: Prognostic and therapeutic impact on survival. Ann Surg. 2014;260(5):786–92; discussion 792-3. doi:10.1097/SLA.0000000000000965.

    Article  CAS  Google Scholar 

  6. Bollschweiler E, Besch S, Drebber U, et al. Influence of neoadjuvant chemoradiation on the number and size of analyzed lymph nodes in esophageal cancer. Ann Surg Oncol. 2010;17(12):3187–3194. doi:10.1245/s10434-010-1196-8.

    Article  PubMed  Google Scholar 

  7. Robb WB, Dahan L, Mornex F, et al. Impact of neoadjuvant chemoradiation on lymph node status in esophageal cancer: Post hoc analysis of a randomized controlled trial. Ann Surg. 2015;261(5):902–908. doi:10.1097/SLA.0000000000000991.

    Article  PubMed  Google Scholar 

  8. Mariette C, Piessen G, Briez N, Triboulet JP. The number of metastatic lymph nodes and the ratio between metastatic and examined lymph nodes are independent prognostic factors in esophageal cancer regardless of neoadjuvant chemoradiation or lymphadenectomy extent. Ann Surg. 2008;247(2):365–371. doi:10.1097/SLA.0b013e31815aaadf.

    Article  PubMed  Google Scholar 

  9. Greenstein AJ, Litle VR, Swanson SJ, Divino CM, Packer S, Wisnivesky JP. Effect of the number of lymph nodes sampled on postoperative survival of lymph node-negative esophageal cancer. Cancer. 2008;112(6):1239–1246. doi:10.1002/cncr.23309.

    Article  PubMed  Google Scholar 

  10. Bhamidipati CM, Stukenborg GJ, Thomas CJ, Lau CL, Kozower BD, Jones DR. Pathologic lymph node ratio is a predictor of survival in esophageal cancer. Ann Thorac Surg. 2012;94(5):1643–1651. doi:10.1016/j.athoracsur.2012.03.078.

    Article  PubMed  Google Scholar 

  11. Hsu WH, Hsu PK, Hsieh CC, Huang CS, Wu YC. The metastatic lymph node number and ratio are independent prognostic factors in esophageal cancer. J Gastrointest Surg. 2009;13(11):1913–1920. doi:10.1007/s11605-009-0982-8.

    Article  PubMed  Google Scholar 

  12. Berger AC, Farma J, Scott WJ, et al. Complete response to neoadjuvant chemoradiotherapy in esophageal carcinoma is associated with significantly improved survival. J Clin Oncol. 2005;23(19):4330–4337.

    Article  PubMed  Google Scholar 

  13. Herr HW. Superiority of ratio based lymph node staging for bladder cancer. J Urol. 2003;169(3):943–945. doi:10.1097/01.ju.0000032474.22093.06.

    Article  PubMed  Google Scholar 

  14. Nitti D, Marchet A, Olivieri M, et al. Ratio between metastatic and examined lymph nodes is an independent prognostic factor after D2 resection for gastric cancer: Analysis of a large European monoinstitutional experience. Ann Surg Oncol. 2003;10(9):1077–1085.

    Article  PubMed  Google Scholar 

  15. Vinh-Hung V, Verschraegen C, Promish DI, et al. Ratios of involved nodes in early breast cancer. Breast Cancer Res. 2004;6(6):R680–8.

    Article  PubMed  PubMed Central  Google Scholar 

  16. Lee HY, Choi HJ, Park KJ, et al. Prognostic significance of metastatic lymph node ratio in node-positive colon carcinoma. Ann Surg. Oncol. 2007;14(5):1712–1717. doi:10.1245/s10434-006-9322-3.

    Article  PubMed  Google Scholar 

  17. Berger AC, Watson JC, Ross EA, Hoffman JP. The metastatic/examined lymph node ratio is an important prognostic factor after pancreaticoduodenectomy for pancreatic adenocarcinoma. Am Surg. 2004;70(3):235–40; discussion 240.

    PubMed  Google Scholar 

  18. Berger AC, Sigurdson ER, LeVoyer T, et al. Colon cancer survival is associated with decreasing ratio of metastatic to examined lymph nodes. J Clin Oncol. 2005;23(34):8706–8712.

    Article  Google Scholar 

  19. Edge SB, Compton CC. The American Joint Committee on Cancer: The 7th edition of the AJCC cancer staging manual and the future of TNM. Ann Surg Oncol. 2010;17(6):1471–1474. doi:10.1245/s10434-010-0985-4.

    Article  PubMed  Google Scholar 

  20. Palazzo F, Evans NR, 3rd, Rosato EL. Minimally invasive esophagectomy with extracorporeal gastric conduit creation—how I do it. J Gastrointest Surg. 2013;17(9):1683–1688. doi:10.1007/s11605-013-2272-8.

    Article  PubMed  Google Scholar 

  21. Palazzo F, Rosato EL, Chaudhary A, et al. Minimally invasive esophagectomy provides significant survival advantage compared with open or hybrid esophagectomy for patients with cancers of the esophagus and gastroesophageal junction. J Am Coll Surg. 2015;220(4):672–679. doi:10.1016/j.jamcollsurg.2014.12.023.

    Article  Google Scholar 

  22. Berger AC, Bloomenthal A, Weksler B, et al. Oncologic efficacy is not compromised, and may be improved with minimally invasive esophagectomy. J Am Coll Surg. 2011;212(4):560–6; discussion 566-8. doi:10.1016/j.jamcollsurg.2010.12.042.

    Article  PubMed  Google Scholar 

  23. Robb WB, Maillard E, Mariette C. Lymph node status after neoadjuvant chemoradiotherapy for esophageal cancer: Implications for the extent of lymphadenectomy. Ann Surg. 2015. doi:10.1097/SLA.0000000000001403.

  24. Wilson M, Rosato EL, Chojnacki KA, et al. Prognostic significance of lymph node metastases and ratio in esophageal cancer. J Surg Res. 2008;146(1):11–15.

    Article  PubMed  Google Scholar 

  25. Rizk NP, Ishwaran H, Rice TW, et al. Optimum lymphadenectomy for esophageal cancer. Ann Surg. 2010;251(1):46–50. doi:10.1097/SLA.0b013e3181b2f6ee.

    Article  PubMed  Google Scholar 

  26. Fox M, Farmer R, Scoggins CR, McMasters KM, Martin RC, 2nd Lymph node ratio is a significant predictor of disease-specific mortality in patients undergoing esophagectomy for cancer. Am Surg. 2012;78(5):528–534.

  27. Chirieac LR, Swisher SG, Ajani JA, et al. Posttherapy pathologic stage predicts survival in patients with esophageal carcinoma receiving preoperative chemoradiation. Cancer. 2005;103(7):1347–1355. doi:10.1002/cncr.20916.

    Article  PubMed  Google Scholar 

  28. Schneider PM, Baldus SE, Metzger R, et al. Histomorphologic tumor regression and lymph node metastases determine prognosis following neoadjuvant radiochemotherapy for esophageal cancer: Implications for response classification. Ann Surg. 2005;242(5):684–692.

    Article  PubMed  PubMed Central  Google Scholar 

  29. Vallbohmer D, Holscher AH, DeMeester S, et al. A multicenter study of survival after neoadjuvant radiotherapy/chemotherapy and esophagectomy for ypT0N0M0R0 esophageal cancer. Ann Surg. 2010;252(5):744–749. doi:10.1097/SLA.0b013e3181fb8dde.

    Article  CAS  PubMed  Google Scholar 

  30. Donohoe CL, O'Farrell NJ, Grant T, et al. Classification of pathologic response to neoadjuvant therapy in esophageal and junctional cancer: Assessment of existing measures and proposal of a novel 3-point standard. Ann Surg. 2013;258(5):784–92; discussion 792. doi:10.1097/SLA.0b013e3182a66588.

    Article  PubMed  Google Scholar 

  31. Tan Z, Ma G, Yang H, Zhang L, Rong T, Lin P. Can lymph node ratio replace pn categories in the tumor-node-metastasis classification system for esophageal cancer? J Thorac Oncol. 2014;9(8):1214–1221. doi:10.1097/JTO.0000000000000216.

    Article  PubMed  Google Scholar 

  32. Kelty CJ, Kennedy CW, Falk GL. Ratio of metastatic lymph nodes to total number of nodes resected is prognostic for survival in esophageal carcinoma. J Thorac Oncol. 2010;5(9):1467–1471.

    Article  PubMed  Google Scholar 

  33. Feng JF, Huang Y, Chen L, Zhao Q. Prognostic analysis of esophageal cancer in elderly patients: Metastatic lymph node ratio versus 2010 AJCC classification by lymph nodes. World J Surg Oncol. 2013;11:162. doi:10.1186/1477-7819-11-162.

    Article  PubMed  PubMed Central  Google Scholar 

  34. Bogoevski D, Onken F, Koenig A, et al. Is it time for a new TNM classification in esophageal carcinoma? Ann Surg. 2008;247(4):633–641. doi:10.1097/SLA.0b013e3181656d07.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Surgery, Thomas Jefferson University Hospital, 1100 Walnut Street, Suite 500, Philadelphia, PA, 19107, USA

    Danica N. Giugliano, Adam C. Berger, Michael J. Pucci, Ernest L. Rosato, Nathaniel R. Evans, Hanna Meidl, Casey Lamb, Daniel Levine & Francesco Palazzo

Authors
  1. Danica N. Giugliano
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Adam C. Berger
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Michael J. Pucci
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Ernest L. Rosato
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Nathaniel R. Evans
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Hanna Meidl
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Casey Lamb
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Daniel Levine
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Francesco Palazzo
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

Danica N. Giugliano, Adam C. Berger, Michael J. Pucci, Ernest L. Rosato, Nathaniel R. Evans, Hanna Meidl, Casey Lamb, Daniel Levine, Francesco Palazzo: contribution meets all criteria

Corresponding author

Correspondence to Danica N. Giugliano.

Ethics declarations

Conflict of Interest

The authors declare that they have no conflict of interest.

Additional information

Meeting Presentations: Quickshot Presentation, American Surgical Congress, February 2, 2016

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Giugliano, D.N., Berger, A.C., Pucci, M.J. et al. Comparative Quantitative Lymph Node Assessment in Localized Esophageal Cancer Patients After R0 Resection With and Without Neoadjuvant Chemoradiation Therapy. J Gastrointest Surg 21, 1377–1384 (2017). https://doi.org/10.1007/s11605-017-3478-y

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11605-017-3478-y

Keywords

Search

Navigation