Residual lymph node disease and mortality following neoadjuvant chemoradiation and curative esophagectomy for distal esophageal adenocarcinoma

Abstract

Objectives: Neoadjuvant chemoradiation has been shown to improve survival in locally advanced esophageal and gastroesophageal junction cancer. The purpose of our study was to examine the effects of posttreatment persistent lymph node (LN) disease on overall survival (OS) and recurrence in patients with esophageal adenocarcinoma after neoadjuvant chemoradiation as well as the effect of LN harvest and the potential benefit of adjuvant chemotherapy. Methods:The records of patients who underwent esophagectomy in our hospital from January 2005 until December 2016 were analyzed. Our study group consisted of 509 patients.Results: Patient groups were created based on pathologic staging after esophagectomy (ypT N) as 22.0% of patients were ypT0 N0, 46.2% had incomplete response only at the primary tumor level (ypT þ N0), and 31.8% had at least 1 metastatic lymph node (ypTx Nþ). Median OS was 58.3 months. The ypTx Nþ group was divided into ypTx N1 and ypTx N2 or N3 subgroups based on the number of metastatic lymph nodes. The OS between the 2 groups was not significantly different (median OS, 37.6 vs 29.8 months; P ¼ .097). The disease-free survival did show a statistically significant difference (median disease-free survival, 27.6 vs 13.7 months; P ¼ .007). The LN harvest was not found to be significantly associated with OS. However, administration of adjuvant chemotherapy was a significant prognosticator for increased OS (hazard ratio, 0.590; P ¼ .043).

Commentary: Adjuvant chemotherapy after trimodal therapy for esophageal carcinoma: A bitter pill to swallow

“…Kandilis and colleagues 4 assessed the influence of persistently positive nodal disease after neoadjuvant chemoradiation on survival for 509 esophageal adenocarcinoma patients who underwent esophagectomy at their institution over a 12-year period. 4 Similar to prior studies, they noted a 22% complete pathologic response rate for adenocarcinomas treated with neoadjuvant chemoradiation, highlighting the importance of at least careful consideration of esophagectomy independent of radiographic response to neoadjuvant therapy.…”

“…The influence on disease-free survival was more profound for those with N2 or N3 compared with N1 disease. 4 …”

Commentary: Systemic adjuvant therapy for esophageal adenocarcinoma

“…In the current issue of JTCVS Open , Kandilis and colleagues 2 report on survival after neoadjuvant therapy and esophagectomy in patients with adenocarcinoma of the distal esophagus. For this study, the patients were divided into 3 groups based on pathologic staging after neoadjuvant therapy and resection: patients with a complete response (ypT0N0, 22%), patients with residual tumor (ypT + N0, 46.2%), and patients at least 1 positive lymph node (ypTanyN1-3, 31.8%).…”