Supraclavicular and/or celiac lymph node metastases from thoracic esophageal squamous cell carcinoma did not compromise survival following neoadjuvant chemoradiotherapy and surgery.

Won Kyung Cho,Myung-Ju Ahn,Yong Chan Ahn,Dongryul Oh,Jong-Mu Sun,Jae Ill Zo,Keunchil Park,Young Mog Shim

doi:10.18632/oncotarget.12200

Won Kyung Cho, Myung-Ju Ahn + Show 6 more

Open Access

https://doi.org/10.18632/oncotarget.12200

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Journal: Oncotarget	Publication Date: Sep 22, 2016
Citations: 6	License type: cc-by

Affiliation: Samsung Medical Center, Sungkyunkwan University

Abstract

This study is to evaluate the prognostic significance of supraclavicular and/or celiac lymph node (LN) metastases in locally advanced thoracic esophageal squamous cell carcinoma (ESCC) patients treated with neoadjuvant chemoradiotherapy (NACRT) and surgery. Among the total 199 patients, 75 (37.7%) had supraclavicular and/or celiac LN metastasis. Surgery was performed following NACRT in 168 patients (84.4%). After the median 18.7 (1.0-147.2) months’ follow-up, 2-year rates of progression-free survival (PFS) and overall survival (OS) in all patients were 48.1% and 65.7%, respectively. In multivariate analyses, negative surgical margin (p < 0.001), ypT0 stage (p = 0.004), and ypN0 stage (p = 0.020) were significantly favorable factors for PFS, and negative surgical margin (p < 0.001) was the only significantly favorable factor for OS. Metastasis to the supraclavicular and/or celiac LNs was significant factor neither for PFS (p = 0.311) nor OS (p = 0.515). Supraclavicular and/or celiac LN metastasis did not compromise the clinical outcomes following NACRT and surgery.

Highlights

The prognosis of resectable esophageal cancer remains still unsatisfactory with 5-year overall survival (OS) rates of 15%~34% [1, 2]
Supraclavicular and celiac lymph node (LN) were defined as non-regional LNs of thoracic esophageal cancer in the 6th American Joint Committee on Cancer (AJCC) staging system
A number of evidence had suggested that supraclavicular and/or celiac LN metastasis does not compromise prognosis compared to other regional LN metastasis [8,9,10,11]

Summary

Introduction

The prognosis of resectable esophageal cancer remains still unsatisfactory with 5-year overall survival (OS) rates of 15%~34% [1, 2]. A multicenter randomized trial demonstrated that the addition of neoadjuvant chemoradiotherapy (NACRT) and surgery improved OS at 5 years when compared to surgical resection alone in patients with resectable stage (T2-3N0-1M0) (47% vs 34%, p = 0.003) [3]. Several meta-analyses concluded that NACRT and surgery showed survival benefit when compared to surgery with or without neoadjuvant chemotherapy in locally advanced esophageal cancer [4, 5]. NACRT and surgery has been recommended as the standard treatment in resectable locally advanced esophageal cancer. Esophageal cancer can spread bidirectionally through the lymphatics to reach remote locations ranging from the cervical to abdominal lymph nodes (LNs). Cervical LN metastasis from upper thoracic esophageal cancer and celiac LN metastasis from lower thoracic esophageal cancer were classified as M1a stage considering the distance between the primary tumor and metastatic LNs, metastases to more distantly located LNs were www.impactjournals.com/oncotarget

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