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Distribution of lymph node metastases in esophageal adenocarcinoma after neoadjuvant chemoradiation therapy: a prospective study

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Abstract

Background

The distribution of lymph node metastases in esophageal adenocarcinoma following neoadjuvant chemoradiation (nCRTx) is unclear, but may have consequences for radiotherapy and surgery. The aim of this study was to define the distribution of lymph node metastases and relation to the radiation field in patients following nCRTx and esophagectomy.

Methods

Between April 2014 and August 2015 esophageal adenocarcinoma patients undergoing transthoracic esophagectomy with 2-field lymphadenectomy following nCRTx were included in this prospective observational study. Lymph node stations according to AJCC 7 were separately investigated. The location of lymph node metastases in relation to the radiation field was determined. The primary endpoint was the distribution of lymph node metastases and relation to the radiation field, the secondary endpoints were high-risk stations and risk factors for lymph node metastases and relation to survival.

Results

Fifty consecutive patients were included. Lymph node metastases were found in 60% of patients and most frequently observed in paraesophageal (28%), left gastric artery (24%), and celiac trunk (18%) stations. Fifty-two percent had lymph node metastases within the radiation field. The incidence of lymph node metastases correlated significantly with ypT-stage (p = 0.002), cT-stage (p = 0.005), lymph angioinvasion (p = 0.004), and Mandard (p = 0.002). The number of lymph node metastases was associated with survival in univariable analysis (HR 1.12, 95% CI 1.068–1.173, p < 0.001).

Conclusions

Esophageal adenocarcinoma frequently metastasizes to both the mediastinal and abdominal lymph node stations. In this study, more than half of the patients had lymph node metastases within the radiation field. nCRTx is therefore not a reason to minimize lymphadenectomy in patients with esophageal adenocarcinoma.

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Authors and Affiliations

  1. Department of Surgery, Amsterdam UMC (Location AMC), University of Amsterdam, Cancer Center Amsterdam, 1105 AZ, Amsterdam, The Netherlands

    Eliza R. C. Hagens, Anne-Sophie van Rijswijk, Mark I. van Berge Henegouwen & Suzanne S. Gisbertz

  2. Department of Gastroenterology and Hepatology, Amsterdam UMC (Location AMC), University of Amsterdam, Cancer Center Amsterdam, Amsterdam, The Netherlands

    Hannah T. Künzli & Bas L. A. M. Weusten

  3. Department of Pathology, Amsterdam UMC (Location AMC), University of Amsterdam, Cancer Center Amsterdam, Amsterdam, The Netherlands

    Sybren L. Meijer & R. Clinton D. Mijnals

  4. Department of Radiotherapy, Amsterdam UMC (Location AMC), University of Amsterdam, Cancer Center Amsterdam, Amsterdam, The Netherlands

    E. Debby Geijsen

  5. Department of Medical Oncology, Amsterdam UMC (Location AMC), University of Amsterdam, Cancer Center Amsterdam, Amsterdam, The Netherlands

    Hanneke W. M. van Laarhoven

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  1. Eliza R. C. Hagens
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Correspondence to Suzanne S. Gisbertz.

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Disclosure

Drs Hagens, Künzli, van Rijswijk, Meijer, Mijnals, Geijsen, and Gisbertz have no conflicts of interest of financial ties to disclose. van Berge Henegouwen has served as consultant for Medtronic and has received unrestricted research funding from Olympus and Stryker. Hanneke W. M. van Laarhoven has served as a consultant for BMS, Celgene, Lilly, and Nordic and has received unrestricted research funding from Bayer, Celgene, Lilly, Merck Serono, MSD, Nordic, Philips, and Roche. Bas Weusten received research support for IRB approved studies from GI Solutions Covidien, Erbe, and C2 Therapeutics. He received a honorarium consultancy speakers fee of Boston Scientific and C2Therapeutics.

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Hagens, E.R.C., Künzli, H.T., van Rijswijk, AS. et al. Distribution of lymph node metastases in esophageal adenocarcinoma after neoadjuvant chemoradiation therapy: a prospective study. Surg Endosc 34, 4347–4357 (2020). https://doi.org/10.1007/s00464-019-07205-y

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