Abstract
Background: The present study aimed to determine the prognostic value of the size of metastatic lymph node (LN) in non-surgical patients with esophageal squamous cell carcinoma (ESCC).Methods: Three hundred seventy-six ESCC patients treated with definitive (chemo-) radiotherapy from January 2013 to March 2016 were reviewed. We analyzed potential associations of metastatic nodal size with responses, patterns of failure, and survival. Log-rank testing and Cox proportional hazards regression models were used to assess the impact of the clinical factors on survival.Results: The 3-years over survival (OS) rates following a median follow-up of 28.2 months were 53.2, 46.2, 35.5, and 22.7% for the N0 group, the >0.5 to ≤1 cm group, the >1 to ≤2 cm group, and the >2 cm group, respectively. The progression-free survival (PFS) rates for 2 years were 50.9, 44.2, 26.6, and 23.4% for the N0 group, the >0.5 to ≤1 cm group, the >1 to ≤2 cm group, and the >2 cm group, respectively. The objective response rates (ORR) for the 280 patients with metastatic LNs were 43.1% for the LN >0.5 to ≤1 cm group, 46.9% for the LN >1 to ≤2 cm group, and 25.5% for the LN ≥2 cm group. The LN >2 cm group had the worst ORR of the three groups with LNs. Gross tumor volume (GTV) failure was the most common failure pattern, followed by distant failure and out of GTV LN failure, with incidences of 47.9% (180 of 376), 42% (158 of 376), and 13.8% (52 of 376), respectively. Nodal size correlated statistically with GTV failure and distant failure but not with out-of-GTV nodal failure. After adjusting for age, sex, T category, Primary tumor location, and CRT, the size of metastatic LNs was an independent prognostic factor for OS and PFS in multivariate analyses.Conclusions: Nodal size is one of prognostic factors for non-surgical patients with ESCC and correlated statistically with GTV failure and distant failure.
Highlights
Esophageal cancer (EC) was ranked seventh in terms of incidence and sixth in terms of mortality globally in 2018 [1]
Esophageal squamous cell carcinoma (ESCC) patients who are unfit for surgery or some medications are often treated with a combined-modality treatment with radiotherapy plus concurrent chemotherapy [2, 3]
Based on lymph nodes (LNs)’ responses, patients with metastatic LNs were divided into 2 separate groups: the partial response (PR)+complete response (CR) group and stable disease (SD)+progressive disease (PD) group
Summary
Esophageal cancer (EC) was ranked seventh in terms of incidence and sixth in terms of mortality globally in 2018 [1]. The 8th American Joint Committee on Cancer (AJCC) tumor-node-metastasis staging system is applied to define the N categories in reference to the number of metastatic lymph nodes. This system is generally controversial for patients with non-surgical EC [8]. Bulky lymph node metastasis is a particular pattern that was included in the N classification for head and neck carcinoma, and non-surgical therapy has adopted it as an important modality This pattern is relevant in other kinds of malignancies, but its role in esophageal cancer patients is still unclear. The present study aimed to determine the prognostic value of the size of metastatic lymph node (LN) in non-surgical patients with esophageal squamous cell carcinoma (ESCC)
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