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Reliability of clinical nodal status regarding response to neoadjuvant chemoradiotherapy compared with surgery alone and prognosis in esophageal cancer patients.
Acta Oncol 2019; 58(11):1640-1647AO

Abstract

Background:

Clinical nodal (cN) staging is a key element in treatment decisions in patients with esophageal cancer (EC). The reliability of cN status regarding the effect on response and survival after neoadjuvant chemoradiotherapy (nCRT) with esophagectomy was evaluated in determining the up- and downstaged pathological nodal (pN) status after surgery alone. Material and methods: From a prospective database, we included all 395 EC patients who had surgery with curative intent with or without nCRT between 2000 and 2015. All patients were staged by a standard pretreatment protocol: 16-64 mdCT, 18 F-FDG-PET or 18 F-FDG-PET/CT and EUS ± FNA. After propensity score matching on baseline clinical tumor and nodal (cT/N) stage and histopathology, a surgery-alone and nCRT group (each N = 135) were formed. Clinical and pathological N stage was scored as equal (cN = pN), downstaged (cN > pN) or upstaged (cN < pN). Prognostic impact on disease free survival (DFS) was assessed with multivariable Cox regression analysis (factors with p value <.1 on univariable analysis).

Results:

The surgery-alone and nCRT group did not differ in cT/N status. Pathologic examination revealed equal staging (32 vs. 27%), nodal up (43 vs. 16%) and downstaging (25 vs. 56%), respectively (p < .001). Nodal up-staging was common in cT3-4a tumors and adenocarcinomas in the surgery-alone group, while nodal downstaging was found in half of cT1-2 and cT3-4 regardless of tumortype after nCRT. Prognostic factors for DFS were pN (p = .002) and lymph-angioinvasion (p = .016) in surgery-alone, and upper abdominal cN metastases (p = .012) and lymph node ratio (p = .034) in the nCRT group.

Conclusions:

Despite modern staging methods, correct cN staging remains difficult in EC. Nodal overstaging (cN > pN) occurred more often than understaging impeding an adequate assessment of pathologic complete response and prognosis after nCRT.

Authors+Show Affiliations

Department of Surgical Oncology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.Department of Surgical Oncology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.Department of Gastroenterology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.Department of Pathology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.Department of Epidemiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.Department of Radiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.Department of Radiation Oncology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.Department of Medical Oncology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.Department of Surgical Oncology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

31397195

Citation

Dijksterhuis, Willemieke P M., et al. "Reliability of Clinical Nodal Status Regarding Response to Neoadjuvant Chemoradiotherapy Compared With Surgery Alone and Prognosis in Esophageal Cancer Patients." Acta Oncologica (Stockholm, Sweden), vol. 58, no. 11, 2019, pp. 1640-1647.
Dijksterhuis WPM, Hulshoff JB, van Dullemen HM, et al. Reliability of clinical nodal status regarding response to neoadjuvant chemoradiotherapy compared with surgery alone and prognosis in esophageal cancer patients. Acta Oncol. 2019;58(11):1640-1647.
Dijksterhuis, W. P. M., Hulshoff, J. B., van Dullemen, H. M., Kats-Ugurlu, G., Burgerhof, J. G. M., Korteweg, T., ... Plukker, J. T. M. (2019). Reliability of clinical nodal status regarding response to neoadjuvant chemoradiotherapy compared with surgery alone and prognosis in esophageal cancer patients. Acta Oncologica (Stockholm, Sweden), 58(11), pp. 1640-1647. doi:10.1080/0284186X.2019.1648865.
Dijksterhuis WPM, et al. Reliability of Clinical Nodal Status Regarding Response to Neoadjuvant Chemoradiotherapy Compared With Surgery Alone and Prognosis in Esophageal Cancer Patients. Acta Oncol. 2019;58(11):1640-1647. PubMed PMID: 31397195.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Reliability of clinical nodal status regarding response to neoadjuvant chemoradiotherapy compared with surgery alone and prognosis in esophageal cancer patients. AU - Dijksterhuis,Willemieke P M, AU - Hulshoff,Jan Binne, AU - van Dullemen,Hendrik M, AU - Kats-Ugurlu,Gursah, AU - Burgerhof,Johannes G M, AU - Korteweg,Tijmen, AU - Mul,Veronique E M, AU - Hospers,Geke A P, AU - Plukker,John T M, Y1 - 2019/08/09/ PY - 2019/8/10/pubmed PY - 2019/8/10/medline PY - 2019/8/10/entrez SP - 1640 EP - 1647 JF - Acta oncologica (Stockholm, Sweden) JO - Acta Oncol VL - 58 IS - 11 N2 - Background: Clinical nodal (cN) staging is a key element in treatment decisions in patients with esophageal cancer (EC). The reliability of cN status regarding the effect on response and survival after neoadjuvant chemoradiotherapy (nCRT) with esophagectomy was evaluated in determining the up- and downstaged pathological nodal (pN) status after surgery alone. Material and methods: From a prospective database, we included all 395 EC patients who had surgery with curative intent with or without nCRT between 2000 and 2015. All patients were staged by a standard pretreatment protocol: 16-64 mdCT, 18 F-FDG-PET or 18 F-FDG-PET/CT and EUS ± FNA. After propensity score matching on baseline clinical tumor and nodal (cT/N) stage and histopathology, a surgery-alone and nCRT group (each N = 135) were formed. Clinical and pathological N stage was scored as equal (cN = pN), downstaged (cN > pN) or upstaged (cN < pN). Prognostic impact on disease free survival (DFS) was assessed with multivariable Cox regression analysis (factors with p value <.1 on univariable analysis). Results: The surgery-alone and nCRT group did not differ in cT/N status. Pathologic examination revealed equal staging (32 vs. 27%), nodal up (43 vs. 16%) and downstaging (25 vs. 56%), respectively (p < .001). Nodal up-staging was common in cT3-4a tumors and adenocarcinomas in the surgery-alone group, while nodal downstaging was found in half of cT1-2 and cT3-4 regardless of tumortype after nCRT. Prognostic factors for DFS were pN (p = .002) and lymph-angioinvasion (p = .016) in surgery-alone, and upper abdominal cN metastases (p = .012) and lymph node ratio (p = .034) in the nCRT group. Conclusions: Despite modern staging methods, correct cN staging remains difficult in EC. Nodal overstaging (cN > pN) occurred more often than understaging impeding an adequate assessment of pathologic complete response and prognosis after nCRT. SN - 1651-226X UR - https://www.unboundmedicine.com/medline/citation/31397195/Reliability_of_clinical_nodal_status_regarding_response_to_neoadjuvant_chemoradiotherapy_compared_with_surgery_alone_and_prognosis_in_esophageal_cancer_patients L2 - http://www.tandfonline.com/doi/full/10.1080/0284186X.2019.1648865 DB - PRIME DP - Unbound Medicine ER -