Distribution of Lymph Node Metastasis in Esophageal Squamous Cell Carcinoma After Trimodal Therapy
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ORIGINAL ARTICLE – THORACIC ONCOLOGY
Distribution of Lymph Node Metastasis in Esophageal Squamous Cell Carcinoma After Trimodal Therapy Yoichi Hamai, MD, PhD1, Manabu Emi, MD, PhD1, Yuta Ibuki, MD1, Tomoaki Kurokawa, MD1, Toru Yoshikawa, MD1, Manato Ohsawa, MD1, Ryosuke Hirohata, MD1, Yuji Murakami, MD, PhD2, Ikuno Nishibuchi, MD, PhD2, Nobuki Imano, MD2, Yasushi Nagata, MD, PhD2, and Morihito Okada, MD, PhD1 Department of Surgical Oncology, Hiroshima University, Hiroshima, Japan; 2Department of Radiation Oncology, Hiroshima University, Hiroshima, Japan 1
ABSTRACT Background. Although metastatic tumors in lymph nodes (LN) are potentially affected by neoadjuvant chemoradiotherapy (NCRT), the distribution of LN metastases of esophageal squamous cell carcinoma (ESCC) after trimodal therapy has never been sufficiently estimated. Patients and Methods. We evaluated the distribution of LN metastases, relationships between LN metastases and radiation fields, risk factors for LN metastasis, and the influence of LN metastasis on the survival of 184 patients with ESCC who underwent NCRT followed by esophagectomy. Results. Neoadjuvant chemoradiotherapy resulted in down-staged LN status in 74 (49.3%) patients. Pathological LN metastases were extensive in 177 LN stations in the cervical, mediastinal, and abdominal fields, and 162 (91.5%) metastases were located inside the radiation fields. Multivariate analysis showed that clinical N stage [N0 vs. 1/2/3: hazard ratio (HR), 2.69; 95% confidence interval (CI), 1.22–5.92; p = 0.01] and clinical response of primary tumor (complete vs. noncomplete: HR, 2.93; 95% CI, 1.50–5.69; p = 0.002) were statistically significant for pathological LN metastasis. Recurrence-free and overall
Electronic supplementary material The online version of this article (https://doi.org/10.1245/s10434-020-09106-0) contains supplementary material, which is available to authorized users. Ó Society of Surgical Oncology 2020 First Received: 24 April 2020 Accepted: 15 August 2020 Y. Hamai, MD, PhD e-mail: [email protected]
survivals were significantly stratified according to the number of pathological LN metastases, associations between clinical and pathological LN metastases, and presence or absence of pathological LN metastases outside radiation field. Conclusions. About 50% of patients who were clinically diagnosed with LN metastasis before treatment were downstaged by NCRT, and their prognoses were relatively good. However, LN metastases were extensive at the cervical, mediastinal, and abdominal areas, even within the radiation field. Thus, systematic and adequate lymphadenectomy is required for ESCC treated by NCRT.
Trimodal therapy comprising neoadjuvant chemoradiotherapy (NCRT) followed by surgery is frequently administered for local control and to improve the survival of patients with locally advanced, resectable esophageal cancer.1,2 Because the frequency of lymph node (LN) metastasis is high from the early stage of esophageal cancer, pathological LN metastases are frequently found after surgery in
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