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Completely Resectable (cT1-2) Esophageal Squamous Cell Carcinoma with Minimal Lymph Node Involvement (cN1): Is Neoadjuvant Chemoradiation Therapy the Only Viable Treatment Option?

  • Thoracic Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Neoadjuvant chemoradiation therapy (nCRT) is recommended when lymph node metastasis is evident or strongly suspected on preoperative imaging studies, even for a completely resectable (cT1-2) tumor with minimal lymph node involvement (cN1). We evaluated the validity of upfront surgical approach in this patient group.

Methods

We retrospectively reviewed data from 247 patients with cT1-2 esophageal squamous cell carcinoma (ESCC) who underwent upfront radical esophagectomy followed by the pathology-based adjuvant treatment. Oncologic outcomes of cN1 patients were compared with those of cN0 patients.

Results

There were 203 cN0 and 44 cN1 patients. The lymph node yield was 62.0 (interquartile range [IQR], 51.0–76.0) in cN0 and 65.5 (IQR, 57.5–85.0) in cN1 patients (p = 0.033). The size of metastatic node was 0.6 cm (IQR, 0.4–0.9 cm) in cN0 and 0.8 cm (IQR, 0.5–1.3 cm) in cN1 patients (p = 0.001). Nodal upstaging was identified in 29.1% of cN0 and 40.9% of cN1 patients, whereas 18.2% of the cN1 had no actual lymph node metastasis (pN0). The 5-year disease-free survival rate was not significantly different between the groups (cN0, 74.4%; cN1, 71.8%; p = 0.529). Survival rates were closely correlated with pN stage, and a multivariate analysis revealed that pN2-3 stage was a risk factor for poor disease-free survival.

Conclusions

Upfront radical surgery provided accurate nodal staging information, potentially sparing some cN1 patients from unnecessary nCRT while demonstrating comparable survival rates. It might be a valid option for the treatment of cT1-2N1 ESCC.

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Acknowledgment

All authors declare that they have no conflict of interest or financial ties to disclose.

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Authors and Affiliations

  1. Department of Thoracic and Cardiovascular Surgery, Yonsei University College of Medicine, Seoul, Republic of Korea

    Young Ho Yang MD, Byung Jo Park MD, PhD, Ha Eun Kim MD & Dae Joon Kim MD, PhD

  2. Department of Pathology, Yonsei University College of Medicine, Seoul, Republic of Korea

    Hyunki Kim MD, PhD

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  1. Young Ho Yang MD
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  2. Byung Jo Park MD, PhD
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  3. Ha Eun Kim MD
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  4. Hyunki Kim MD, PhD
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  5. Dae Joon Kim MD, PhD
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Correspondence to Dae Joon Kim MD, PhD.

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Yang, Y.H., Park, B.J., Kim, H.E. et al. Completely Resectable (cT1-2) Esophageal Squamous Cell Carcinoma with Minimal Lymph Node Involvement (cN1): Is Neoadjuvant Chemoradiation Therapy the Only Viable Treatment Option?. Ann Surg Oncol 31, 2490–2498 (2024). https://doi.org/10.1245/s10434-023-14756-x

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