A More Extensive Lymphadenectomy Enhances Survival After Neoadjuvant Chemoradiotherapy in Locally Advanced Esophageal Adenocarcinoma. Academic Article uri icon

Overview

abstract

  • OBJECTIVE: We sought to determine the extent of lymphadenectomy that optimizes staging and survival in patients with locally advanced EAC treated with neoadjuvant chemoradiotherapy followed by esophagectomy. SUMMARY OF BACKGROUND DATA: Several studies have found that a more extensive lymphadenectomy leads to better disease-specific survival in patients treated with surgery alone. Few studies, however, have investigated whether this association exists for patients treated with neoadjuvant chemoradiotherapy. METHODS: We examined our prospective database and identified patients with EAC treated with neoadjuvant chemoradiotherapy followed by esophagectomy between 1995 and 2017. Overall survival (OS) and DFS were estimated using Kaplan-Meier methods, and a multivariable Cox proportional hazards model was used to identify independent predictors of OS and DFS. The relationship between the total number of nodes removed and 5-year OS or DFS was plotted using restricted cubic spline functions. RESULTS: In total, 778 patients met the inclusion criteria. The median number of excised nodes was 21 (interquartile range, 16-27). A lower number of excised lymph nodes was independently associated with worse OS and DFS (OS: hazard ratio, 0.98; confidence interval, 0.97-1.00; P = 0.013; DFS: hazard ratio, 0.99; confidence interval, 0.98-1.00; P = 0.028). Removing 25 to 30 lymph nodes was associated with a 10% risk of missing a positive lymph node. Both OS and DFS improved with up to 20 to 25 lymph nodes removed, regardless of treatment response. CONCLUSIONS: The optimal extent of lymphadenectomy to enhance both staging and survival after chemoradiotherapy, regardless of treatment response, is approximately 25 lymph nodes.

authors

  • Sihag, Smita
  • Nobel, Tamar
  • Hsu, Meier
  • Tan, Kay See
  • Carr, Rebecca
  • Janjigian, Yelena Y
  • Tang, Laura H
  • Wu, Abraham J
  • Bott, Matthew J
  • Isbell, James M
  • Bains, Manjit S
  • Jones, David R
  • Molena, Daniela

publication date

  • November 17, 2020

Research

keywords

  • Adenocarcinoma
  • Esophageal Neoplasms

Identity

PubMed Central ID

  • PMC8114152

Scopus Document Identifier

  • 85134389546

Digital Object Identifier (DOI)

  • 10.1097/SLA.0000000000004479

PubMed ID

  • 33201124

Additional Document Info

volume

  • 276

issue

  • 2