The effect of neoadjuvant chemotherapy on lymph node micrometastases in squamous cell carcinomas of the thoracic esophagus

Prognostic Significance of Simultaneous Presence of Histological and Immunohistochemical Metastasis to Lymph Nodes in Patients with Esophageal Cancer

“…13) Based on observation of a significant reduction in iNM prevalence or decreased tumor cell load, as measured by ratio of number of lymph nodes affected by micrometastasis in patients with a major response to neoadjuvant therapy compared to those without a major response, several investigators have suggested that neoadjuvant treatment might improve patient survival through eradication of micro-tumor cells. [14][15][16][17] However, the present study failed to find a significant difference in iNM frequency between patients who had and had not undergone preoperative treatment, although the clinical response rate to preoperative chemotherapy or chemoradiotherapy had been approximately 50% in our prospective cohort study (data not shown). This discrepancy between previous reports and the present study may be explained by a treatment criterion used in this prospective cohort study; namely, that only those patients who initially presented with unfavorable prognostic factors were assigned to undergo preoperative chemotherapy or chemoradiotherapy.…”

“…16) In the present study, iNM status was not found to be a significant predictor of overall survival in patients who had undergone R0 esophagectomy for esophageal cancer, although a trend emerged indicating better overall survival in patients without iNM compared with those with iNM who had undergone preoperative treatment (p = 0.06). However, when the patients were divided by preoperative treatment status, iNM was found to be a significant predictor of poor survival of patients who had not undergone preoperative treatment.…”

“…In other studies, esophageal cancer patients with stage III or IV disease or intramural metastasis have been reported to have a higher prevalence and a greater number of positive nodes compared to patients with Category 1 disease. 16,18) Based on these findings, extensive nodal metastasis is considered a common characteristic of patients with unfavorable prognostic factors, i.e. Category 2 and 3 patients, while less extensive pNM is considered a characteristic of Category 1 patients.…”

Prediction of the response to chemotherapy in advanced esophageal cancer by gene expression profiling of biopsy samples

“…In ESCC patients who underwent NACT and surgery, clinical responders, defined by >50% regression in the area of primary tumor, had a better prognosis than non-responders (21,26). Hence, in this study, patients with a reduction rate of >50% of the primary site were classified as responders, and patients with <50% decrease were classified as nonresponders.…”

“…We performed chemotherapy on ESCC patients with cN1 or cM1(lym) with any cT stage as neoadjuvant therapy or on patients with any cM1 other than lymph node metastasis. The first line chemotherapy protocol was cisplatin combined with adriamycin and 5-fluorouracil (FAP therapy) (20,21). The treatment regimen of FAP therapy was as follows: cisplatin (70 mg/m 2 ) and doxorubicin hydrochroride (adriamycin, 35 mg/m 2 ) were administered by drip infusion on day 1, and 5-fluorouracil (700 mg/m 2 ) was administered by continuous infusion on days 1-7.…”