Number of resected lymph nodes and survival of patients with locally advanced esophageal squamous cell carcinoma receiving preoperative chemoradiotherapy
Journal
Anticancer Research
Journal Volume
38
Journal Issue
3
Pages
1569-1577
Date Issued
2018
Abstract
Background: The association of extended lymph node (LN) dissection with improved outcomes in patients with locally advanced esophageal squamous cell carcinoma (ESCC) who received preoperative chemoradiotherapy (CRT) followed by surgery is debatable. Patients and Methods: We reviewed data from patients with esophageal cancer enrolled in three phase II clinical trials of preoperative paclitaxel and cisplatin-based CRT during 2000-2012. Patients with ESCC who underwent planned esophagectomy were enrolled. The number of resected LNs and other clinicopathological factors were analyzed regarding their impact on progression-free (PFS) and overall (OS) survival using Cox proportional hazards model. Results: In total, 139 patients were included. The median PFS and OS were 24.4 and 31.8 months, respectively. The median number of resected and positive LNs were 19 (range=2-96) and 0 (range=0-9), respectively. The mean number of positive LNs did not differ significantly among quartile groups of total resected LNs (quartile 1: 2-12, 2: 13-19, 3: 20-29, and 4: 30-96). The resected LN number analyzed as dichotomies divided by the median or as continuous variables was not associated with PFS or OS. However, in an exploratory analysis, patients of quartiles 2 and 3 had longer PFS and OS than those with quartiles of 1 and 4 in multivariate analysis (p=0.019 and 0.005, respectively). Conclusion: Although extensive LN dissection was not associated with improved survival, resection of 13-29 LNs was associated with improved survival in patients with locally advanced ESCC receiving preoperative paclitaxel and cisplatin-based CRT. ? 2018 International Institute of Anticancer Research. All rights reserved.
SDGs
Other Subjects
cetuximab; cisplatin; fluorouracil; folinic acid; paclitaxel; adult; advanced cancer; aged; cancer patient; cancer staging; cancer survival; chemoradiotherapy; Conference Paper; drug megadose; esophageal squamous cell carcinoma; esophagus resection; female; human; loading drug dose; lymph node dissection; lymph vessel metastasis; major clinical study; male; multimodality cancer therapy; overall survival; perineural invasion; preoperative care; priority journal; progression free survival; Taiwan; chemoradiotherapy; esophagus tumor; Kaplan Meier method; lymph node; middle aged; multivariate analysis; outcome assessment; pathology; phase 2 clinical trial (topic); preoperative period; procedures; proportional hazards model; squamous cell carcinoma; statistics and numerical data; Adult; Aged; Carcinoma, Squamous Cell; Chemoradiotherapy; Clinical Trials, Phase II as Topic; Esophageal Neoplasms; Esophagectomy; Female; Humans; Kaplan-Meier Estimate; Lymph Node Excision; Lymph Nodes; Male; Middle Aged; Multivariate Analysis; Outcome Assessment (Health Care); Preoperative Period; Proportional Hazards Models
Publisher
International Institute of Anticancer Research
Type
conference paper