Analysis of prognostic factors in patients with lymph node recurrence after radical esophagectomy: importance of locoreg
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ORIGINAL ARTICLE
Analysis of prognostic factors in patients with lymph node recurrence after radical esophagectomy: importance of locoregional therapy Koji Tanaka1 · Makoto Yamasaki1 · Tomoki Makino1 · Kotaro Yamashita1 · Takuro Saitoh1 · Tsuyoshi Takahashi1 · Yukinori Kurokawa1 · Kiyokazu Nakajima1 · Masaaki Motoori2 · Yutaka Kimura3 · Masayuki Mano4 · Masaki Mori5 · Hidetoshi Eguchi1 · Yuichiro Doki1 Received: 6 May 2020 / Accepted: 25 August 2020 © The Japan Esophageal Society 2020
Abstract Purpose Lymph node (LN) recurrence is frequently encountered in esophageal cancer. The aim of this study was to determine the effects of various factors, including loco-regional treatment of LN-only recurrence, on the survival rate. Methods Among 941 patients who underwent curative resection for esophageal squamous cell carcinoma in 2003–2016, we retrospectively reviewed 117 patients (12.4%) who developed LN-only recurrence. Results One, 2, 3, and 4 or more metastatic LNs were found in 72, 22, 6, and 17 patients, respectively, after a median disease-free interval of 8.4 months (range 1.1–62.0). Among all cases, recurrence was out of the surgical field in 53 cases (45.3%). Recurrent LNs were controlled by loco-regional treatment in 29 (43.9%) and by chemotherapy alone in 3 patients (7.0%). The 3-year survival rates of patients who did and did not achieve local control were 53.2% and 5.2%, respectively. Univariate analysis showed significant relationships between post-recurrence survival rate and pStage I–II at initial surgery, no history of radiotherapy, recurrence in ≤ 2 LN, and loco-regional treatment of LN recurrence. Multivariate analysis identified recurrence in ≤ 2 LN (HR 0.3169, 95% CI 0.1023–0.5314, p = 0.0038) and loco-regional treatment (HR 0.1973, 95% CI 0.0075–0.3871, p = 0.0416) as the only two significant and independent prognostic factors of survival. Conclusions Recurrence limited to ≤ 2 LN and loco-regional treatment (chemoradiotheapy or surgery) for LN recurrence were associated with favorable survival of patients with history of radical esophagectomy followed by LN recurrence. Our results emphasize the importance of local control of LN recurrence regardless of location. Keywords Lymph node recurrence · Esophageal cancer · Prognosis
Background
* Koji Tanaka [email protected]‑u.ac.jp 1
Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, 2‑2 Yamadaoka, Suita, Osaka 565‑0871, Japan
2
Department of Surgery, Osaka General Medical Center, Osaka, Japan
3
Department of Surgery, Kindai University Faculty of Medicine, Osaka, Japan
4
Department of Central Laboratory and Surgical Pathology, National Hospital Organization Osaka National Hospital, Osaka 540‑0006, Japan
5
Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
Esophageal cancer is the fifth most common cause of cancerrelated deaths in men and the eighth in women worldwide [1]. The reported incidence of recurrence after curative res
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