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Clinical Impact of Metastatic Lymph Node Size on Therapeutic Effect and Prognosis in Patients with Esophageal Squamous Cell Carcinoma Who Underwent Preoperative Chemotherapy Followed by Esophagectomy

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

Abstract

Background

Pretreatment metastatic lymph node (LN) size has been reported to be associated with prognosis in esophageal squamous cell carcinoma (ESCC). However, its relationship with response to preoperative chemotherapy or prognosis has not been clarified. We investigated the relationship between metastatic LN size and response to preoperative treatment, and prognosis in patients with metastatic esophageal cancer who underwent surgery.

Patients and Methods

A total of 212 clinically node-positive patients who underwent preoperative chemotherapy followed by esophagectomy for ESCC were enrolled. Patients were stratified into three groups on the basis of the length of the short axis of the largest LN in pretreatment computed tomography images: < 10 mm (group A), 10–19 mm (group B), and ≥ 20 mm (group C).

Results

Group A had 90 patients (42%), group B had 103 patients (49%), and group C had 19 patients (9%). Group C had significantly lower percent reduction in total metastatic LN size than groups A and B (22.5% versus 35.7%, P = 0.037). Group C had significantly more metastatic LNs based on histological examination than groups A and B (10.1 versus 2.4, P < 0.001). Group C patients whose LNs responded had significantly fewer metastatic LNs than nonresponders (5.1 versus 11.9, P = 0.042). Group C had significantly poorer overall survival than groups A and B (3-year survival, 25.4% versus 67.3%, P < 0.001). However, group C patients whose LNs responded had better survival than nonresponders (3-year survival, 57.1% versus 0%, P = 0.008).

Conclusions

Patients with large metastatic LNs have poor response and poor prognosis. However, if a response is obtained, long-term survival can be expected.

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Data Availability

The authors declare that the data supporting the findings of this study are available within the article and its supplementary information files.

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Acknowledgement

The authors thank the staff from all the centers that participated in data collection.

Author information

Authors and Affiliations

  1. Department of Digestive Surgery, Osaka International Cancer Institute, Osaka, Japan

    Keijiro Sugimura MD, Hiroshi Miyata MD, Takashi Kanemura MD, Tomohira Takeoka MD, Takahito Sugase MD, Masaaki Yamamoto MD, Naoki Shinnno MD, Hisashi Hara MD, Takeshi Omori MD, Masayuki Ohue MD & Masahiko Yano MD

  2. Department of Surgery, Kansai Rosai Hospital, Amagasaki City, Hyogo, Japan

    Keijiro Sugimura MD

  3. Department of Surgery, Osaka General Medical Center, Osaka, Japan

    Masaaki Motoori MD

  4. Department of Surgery, Osaka Suita Municipal Hospital, Suita City, Osaka, Japan

    Masahiko Yano MD

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  1. Keijiro Sugimura MD
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Contributions

Conception and design of the study was carried out by KS and HM. Development of the methodology was carried out by KS, HM, TK, TT, and TS. Analysis and interpretation of data was performed by KS, HM, TK, TT, TS, MY, NS, HH, TO, MM, MO, and MY. Writing, review, and revision of the manuscript were performed by KS and HM.

Corresponding author

Correspondence to Keijiro Sugimura MD.

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None to declare. The human ethics review committee of each institution approved the study protocol. Subjects provided written informed consent. This study was performed in accordance with the Declarations of Helsinki.

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Sugimura, K., Miyata, H., Kanemura, T. et al. Clinical Impact of Metastatic Lymph Node Size on Therapeutic Effect and Prognosis in Patients with Esophageal Squamous Cell Carcinoma Who Underwent Preoperative Chemotherapy Followed by Esophagectomy. Ann Surg Oncol 30, 4193–4202 (2023). https://doi.org/10.1245/s10434-023-13393-8

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