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Annals of Surgical Oncology

, Volume 26, Issue 1, pp 200–208 | Cite as

Clinical Impact of the Location of Lymph Node Metastases After Neoadjuvant Chemotherapy for Middle and Lower Thoracic Esophageal Cancer

  • Hiroshi MiyataEmail author
  • Keijirou Sugimura
  • Makoto Yamasaki
  • Tomoki Makino
  • Koji Tanaka
  • Eiichi Morii
  • Takeshi Omori
  • Kazuyoshi Yamamoto
  • Yoshitomo Yanagimoto
  • Masahiko Yano
  • Shinichi Nakatsuka
  • Masaki Mori
  • Yuichiro Doki
Gastrointestinal Oncology
  • 174 Downloads

Abstract

Background

In the current cancer staging systems, the location of lymph node (LN) metastases is not considered, although LN status is defined according to the number of LN metastases.

Objectives

This study aimed to investigate the clinical impact of the location of LN metastases in esophageal cancer and to evaluate the relevance of minimizing the extent of lymphadenectomy after neoadjuvant therapy.

Methods

In 561 patients with esophageal cancer who underwent neoadjuvant chemotherapy, the therapeutic value of each LN dissection was estimated by multiplying the incidence of metastasis by the 5-year survival rate of patients with positive nodes. In addition, we examined whether the value was affected by the response to neoadjuvant therapy.

Results

Metastasis to the celiac LN and middle mediastinal LN regions was identified as an independent prognostic factor by multivariate analysis, together with the number of LN metastases; however metastasis to the cervical LN and upper mediastinal LN regions was not identified as an independent prognostic factor. The therapeutic value was high in recurrent nerve LNs, paraesophageal LNs, paracardial LNs, and left gastric LNs. The therapeutic value for each LN dissection did not change according to the response to neoadjuvant therapy, excluding the lower mediastinal LN and perigastric LN stations for which the value was relatively high in patients with a poor response.

Conclusion

The present study shows that the location and number of LN metastases have a prognostic impact in patients with esophageal cancer undergoing neoadjuvant chemotherapy. Limited lymphadenectomy according to the response to neoadjuvant therapy cannot be justified.

Keywords

Esophageal cancer Neoadjuvant therapy Neoadjuvant chemotherapy Lymph node Metastasis Esophagectomy 

Supplementary material

10434_2018_6946_MOESM1_ESM.tif (2.9 mb)
Fig. 1 Map of each lymph node, defined by the Japanese classification and AJCC cancer staging systems. Each letter represents a lymph node listed in Table 1. Upper: Japanese classification; lower: AJCC cancer staging (TIFF 2980 kb)
10434_2018_6946_MOESM2_ESM.tif (2.3 mb)
Fig. 2 Overall survival rate in 561 patients with esophageal cancer who underwent neoadjuvant chemotherapy followed by surgery, according to the number of metastatic lymph nodes (TIFF 2310 kb)
10434_2018_6946_MOESM3_ESM.tif (2.3 mb)
Fig. 3 Overall survival rate in 561 patients according to the response to neoadjuvant chemotherapy (TIFF 2398 kb)
10434_2018_6946_MOESM4_ESM.docx (35 kb)
Supplementary material 4 (DOCX 34 kb)

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Copyright information

© Society of Surgical Oncology 2018

Authors and Affiliations

  • Hiroshi Miyata
    • 1
    • 3
    Email author
  • Keijirou Sugimura
    • 3
  • Makoto Yamasaki
    • 1
  • Tomoki Makino
    • 1
  • Koji Tanaka
    • 1
  • Eiichi Morii
    • 2
  • Takeshi Omori
    • 3
  • Kazuyoshi Yamamoto
    • 3
  • Yoshitomo Yanagimoto
    • 3
  • Masahiko Yano
    • 3
  • Shinichi Nakatsuka
    • 4
  • Masaki Mori
    • 1
  • Yuichiro Doki
    • 1
  1. 1.Department of Gastroenterological Surgery, Graduate School of MedicineOsaka UniversitySuitaJapan
  2. 2.Department of Pathology, Graduate School of MedicineOsaka UniversityOsakaJapan
  3. 3.Department of Digestive SurgeryOsaka International Cancer InstituteOsakaJapan
  4. 4.Department of PathologyOsaka International Cancer InstituteOsakaJapan

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