Abstract
ObjectivesOesophageal adenocarcinoma has a poor prognosis and relies on multi-modality assessment for accurate nodal staging. The aim of the study was to determine the prognostic significance of nodal concordance between PET/CT and EUS in oesophageal adenocarcinoma.MethodsConsecutive patients with oesophageal adenocarcinoma staged between 2010 and 2016 were included. Groups comprising concordant node–negative (C−ve), discordant (DC), and concordant node–positive (C+ve) patients were analysed. Survival analysis using log-rank tests and Cox proportional hazards model was performed. The primary outcome was overall survival. A p value < 0.05 was considered statistically significant.ResultsIn total, 310 patients (median age = 66.0; interquartile range 59.5–72.5, males = 264) were included. The median overall survival was 23.0 months (95% confidence intervals (CI) 18.73–27.29). There was a significant difference in overall survival between concordance groups (X2 = 44.91, df = 2, p < 0.001). The hazard ratios for overall survival of DC and C+ve patients compared with those of C−ve patients with cT3 tumours were 1.21 (95% CI 0.81–1.79) and 1.79 (95% CI 1.23–2.61), respectively. On multivariable analysis, nodal concordance was significantly and independently associated with overall survival (HR 1.44, 95% CI 1.12–1.83, p = 0.004) and performed better than age at diagnosis (HR 1.02, 95% CI 1.003–1.034, p = 0.016) and current cN-staging methods (HR 1.20, 95% CI 0.978–1.48, p = 0.080).ConclusionsPatients with discordant nodal staging on PET/CT and EUS represent an intermediate-risk group for overall survival. This finding was consistent in patients with cT3 tumours. These findings will assist optimum treatment decisions based upon perceived prognosis for each patient.Key Points• Clinicians are commonly faced with results of discordant nodal staging in oesophageal adenocarcinoma.• There is a significant difference in overall survival between patients with negative, discordant, and positive lymph node staging.• Patients with discordant lymph node staging between imaging modalities represent an intermediate-risk group for overall survival.
Highlights
Oesophageal cancer is newly diagnosed in over 9000 people in the United Kingdom (UK) each year and predominately of adenocarcinoma cell type, with around 7 in 10 diagnosed at an advanced stage [1]
Radiological staging is central to management, planning, and prognosis, and usually involves a combination of computed tomography (CT), positron emission tomography combined with CT (PET/CT), and endoscopic ultrasound (EUS) [2]
This study has shown that patients with discordant nodal staging on PET/CT and EUS represent an intermediate-risk group for overall survival
Summary
Oesophageal cancer is newly diagnosed in over 9000 people in the United Kingdom (UK) each year and predominately of adenocarcinoma cell type, with around 7 in 10 diagnosed at an advanced stage [1]. Radiological staging is central to management, planning, and prognosis, and usually involves a combination of computed tomography (CT), positron emission tomography combined with CT (PET/CT), and endoscopic ultrasound (EUS) [2]. Lymph node metastases are a major prognostic indicator in oesophageal cancer [3, 4]. Nodal assessment is a key factor in radiological staging but the accuracy of these individual modalities is suboptimal [5, 6]. EUS is generally regarded as the gold standard for assessment of regional lymph nodes, but controversy regarding the role of EUS in staging exists. Studies have shown limited benefits versus risk [7] whilst others suggest EUS can impact treatment decisions in 29% of patients [8] and reduce edge of radiotherapy field relapses when EUS measurements are used to define gross tumour volume [9]
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