Skip to main content
Top
Published in: Radiation Oncology 1/2015

Open Access 01-12-2015 | Research

Residual lymph node status is an independent prognostic factor in esophageal squamous cell Carcinoma with pathologic T0 after preoperative radiotherapy

Authors: Qifeng Wang, Shufei Yu, Zefen Xiao, Xiao Liu, Wencheng Zhang, Xun Zhang, Jie He, Kelin Sun, Ting Xu, Qinfu Feng, Zongmei Zhou, Lvhua Wang, Weibo Yin

Published in: Radiation Oncology | Issue 1/2015

Login to get access

Abstract

Objective

To evaluate the prognostic factors affecting survival in esophageal squamous cell Carcinoma (ESCC) patients with pathologic T0 (ypT0) underwent preoperative radiotherapy.

Patients and methods

Two hundred and ninety-six patients with ESCC who had received preoperative radiotherapy from 1980 to 2007 were retrospectively analyzed. One hundred patients were ypT0 after preoperative radiotherapy. Univariate and multivariate analyses were performed to evaluate the predictive impact of residual lymph node status on overall survival (OS) and progression-free survival (PFS).

Results

Among the originally analyzed 296 patients, 100 (33.7 %) patients had ypT0, including 78 patients (78 %) with ypT0N0, and 22 patients (22 %) with ypT0N1. The 5-year OS of the total patients was 42.4 %. Patients with ypT0N0 have significant improved 5-year OS and PFS than ypT0N1 patients (OS: 50.7 % vs 13.6 %, P = 0.004; PFS: 49.6 % vs 13.6 %, P = 0.003). In multivariate analysis, residual lymph node status was also an independent prognostic factors for OS (HR: 0.406, 95 % CI: 0.240–0.686, P = 0.001) and PFS (HR: 0.427, 95 % CI: 0.248–0.734, P = 0.002).

Conclusion

Our results indicate that patients with ypT0N0 after preoperative radiotherapy had significantly better OS and PFS than patients with ypT0N1 in ESCC. Residual nodal metastasis of ESCC patients with pathological complete response of the primary tumor after neoadjuvant radiotherapy does influence prognosis.
Literature
1.
go back to reference Urba SG, Orringer MB, Turrisi A, Iannettoni M, Forastiere A, Strawderman M. Randomized trial of preoperative chemoradiation versus surgery alone in patients with locoregional esophageal carcinoma. J Clin Oncol. 2001;19(2):305–13.PubMed Urba SG, Orringer MB, Turrisi A, Iannettoni M, Forastiere A, Strawderman M. Randomized trial of preoperative chemoradiation versus surgery alone in patients with locoregional esophageal carcinoma. J Clin Oncol. 2001;19(2):305–13.PubMed
2.
go back to reference Heath EI, Burtness BA, Heitmiller RF, Salem R, Kleinberg L, Knisely JP, et al. Phase II evaluation of preoperative chemoradiation and postoperative adjuvant chemotherapy for squamous cell and adenocarcinoma of the esophagus. J Clin Oncol. 2000;18(4):868–76.PubMed Heath EI, Burtness BA, Heitmiller RF, Salem R, Kleinberg L, Knisely JP, et al. Phase II evaluation of preoperative chemoradiation and postoperative adjuvant chemotherapy for squamous cell and adenocarcinoma of the esophagus. J Clin Oncol. 2000;18(4):868–76.PubMed
3.
go back to reference Meluch AA, Greco FA, Gray JR, Thomas M, Sutton VM, Davis JL, et al. Preoperative therapy with concurrent paclitaxel/carboplatin/infusional 5-FU and radiation therapy in locoregional esophageal cancer: final results of a Minnie Pearl Cancer Research Network phase II trial. Cancer J. 2003;9(4):251–60.PubMedCrossRef Meluch AA, Greco FA, Gray JR, Thomas M, Sutton VM, Davis JL, et al. Preoperative therapy with concurrent paclitaxel/carboplatin/infusional 5-FU and radiation therapy in locoregional esophageal cancer: final results of a Minnie Pearl Cancer Research Network phase II trial. Cancer J. 2003;9(4):251–60.PubMedCrossRef
4.
go back to reference Kleinberg L, Knisely JP, Heitmiller R, Zahurak M, Salem R, Burtness B, et al. Mature survival results with preoperative cisplatin, protracted infusion 5-fluorouracil, and 44-Gy radiotherapy for esophageal cancer. Int J Radiat Oncol Biol Phys. 2003;56(2):328–34.PubMedCrossRef Kleinberg L, Knisely JP, Heitmiller R, Zahurak M, Salem R, Burtness B, et al. Mature survival results with preoperative cisplatin, protracted infusion 5-fluorouracil, and 44-Gy radiotherapy for esophageal cancer. Int J Radiat Oncol Biol Phys. 2003;56(2):328–34.PubMedCrossRef
5.
go back to reference Berger AC, Farma J, Scott WJ, Freedman G, Weiner L, Cheng JD, et al. Complete response to neoadjuvant chemoradiotherapy in esophageal carcinoma is associated with significantly improved survival. J Clin Oncol. 2005;23(19):4330–7.PubMedCrossRef Berger AC, Farma J, Scott WJ, Freedman G, Weiner L, Cheng JD, et al. Complete response to neoadjuvant chemoradiotherapy in esophageal carcinoma is associated with significantly improved survival. J Clin Oncol. 2005;23(19):4330–7.PubMedCrossRef
6.
go back to reference Rizk NP, Venkatraman E, Bains MS, Park B, Flores R, Tang L, et al. American Joint Committee on Cancer staging system does not accurately predict survival in patients receiving multimodality therapy for esophageal adenocarcinoma. J Clin Oncol. 2007;25(5):507–12.PubMedCrossRef Rizk NP, Venkatraman E, Bains MS, Park B, Flores R, Tang L, et al. American Joint Committee on Cancer staging system does not accurately predict survival in patients receiving multimodality therapy for esophageal adenocarcinoma. J Clin Oncol. 2007;25(5):507–12.PubMedCrossRef
7.
go back to reference Chirieac LR, Swisher SG, Ajani JA, Komaki RR, Correa AM, Morris JS, et al. Posttherapy pathologic stage predicts survival in patients with esophageal carcinoma receiving preoperative chemoradiation. Cancer. 2005;103(7):1347–55.PubMedCrossRef Chirieac LR, Swisher SG, Ajani JA, Komaki RR, Correa AM, Morris JS, et al. Posttherapy pathologic stage predicts survival in patients with esophageal carcinoma receiving preoperative chemoradiation. Cancer. 2005;103(7):1347–55.PubMedCrossRef
8.
go back to reference van Hagen P, Hulshof MC, van Lanschot JJ, Steyerberg EW, van Berge Henegouwen MI, Wijnhoven BP, et al. Preoperative chemoradiotherapy for esophageal or junctional cancer. N Engl J Med. 2012;366(22):2074–84.PubMedCrossRef van Hagen P, Hulshof MC, van Lanschot JJ, Steyerberg EW, van Berge Henegouwen MI, Wijnhoven BP, et al. Preoperative chemoradiotherapy for esophageal or junctional cancer. N Engl J Med. 2012;366(22):2074–84.PubMedCrossRef
9.
go back to reference Sjoquist KM, Burmeister BH, Smithers BM, Zalcberg JR, Simes RJ, Barbour A, et al. Australasian Gastro-Intestinal Trials G: Survival after neoadjuvant chemotherapy or chemoradiotherapy for resectable oesophageal carcinoma: an updated meta-analysis. Lancet Oncol. 2011;12(7):681–92.PubMedCrossRef Sjoquist KM, Burmeister BH, Smithers BM, Zalcberg JR, Simes RJ, Barbour A, et al. Australasian Gastro-Intestinal Trials G: Survival after neoadjuvant chemotherapy or chemoradiotherapy for resectable oesophageal carcinoma: an updated meta-analysis. Lancet Oncol. 2011;12(7):681–92.PubMedCrossRef
10.
go back to reference Kranzfelder M, Schuster T, Geinitz H, Friess H, Buchler P. Meta-analysis of neoadjuvant treatment modalities and definitive non-surgical therapy for oesophageal squamous cell cancer. Br J Surg. 2011;98(6):768–83.PubMedCrossRef Kranzfelder M, Schuster T, Geinitz H, Friess H, Buchler P. Meta-analysis of neoadjuvant treatment modalities and definitive non-surgical therapy for oesophageal squamous cell cancer. Br J Surg. 2011;98(6):768–83.PubMedCrossRef
11.
go back to reference GJ H, XZ G, LJ W. Experience with combined preoperative irradiation and surgery for carcinoma of the esophagus. Cancer Res. 1986;31:159–64. GJ H, XZ G, LJ W. Experience with combined preoperative irradiation and surgery for carcinoma of the esophagus. Cancer Res. 1986;31:159–64.
12.
go back to reference Wang Mei G, XianZhi HGJ, Yang Z, Wang L, Dongfu C. Randomized trial on combined preoperative irradiation and surgery in the treatment of esophageal carcinoma -- report on 418 patients. Chin J Radiat Oncol. 2001;10(3):168–72. Wang Mei G, XianZhi HGJ, Yang Z, Wang L, Dongfu C. Randomized trial on combined preoperative irradiation and surgery in the treatment of esophageal carcinoma -- report on 418 patients. Chin J Radiat Oncol. 2001;10(3):168–72.
13.
go back to reference Forastiere AA, Orringer MB, Perez-Tamayo C, Urba SG, Zahurak M. Preoperative chemoradiation followed by transhiatal esophagectomy for carcinoma of the esophagus: final report. J Clin Oncol. 1993;11(6):1118–23.PubMed Forastiere AA, Orringer MB, Perez-Tamayo C, Urba SG, Zahurak M. Preoperative chemoradiation followed by transhiatal esophagectomy for carcinoma of the esophagus: final report. J Clin Oncol. 1993;11(6):1118–23.PubMed
14.
go back to reference Kim MP, Correa AM, Lee J, Rice DC, Roth JA, Mehran RJ, et al. Pathologic T0N1 esophageal cancer after neoadjuvant therapy and surgery: an orphan status. Ann Thorac Surg. 2010;90(3):884–90. discussion 890–881.PubMedCrossRef Kim MP, Correa AM, Lee J, Rice DC, Roth JA, Mehran RJ, et al. Pathologic T0N1 esophageal cancer after neoadjuvant therapy and surgery: an orphan status. Ann Thorac Surg. 2010;90(3):884–90. discussion 890–881.PubMedCrossRef
15.
go back to reference Ou GF, Wang M, Wang LH, Yin WB, Gu XZ. Relation between pathologic tumor response to preoperative radiotherapy and the prognosis in patients with esophageal carcinoma. Chin J Radiat Oncol. 2003;25(3):278–81. Ou GF, Wang M, Wang LH, Yin WB, Gu XZ. Relation between pathologic tumor response to preoperative radiotherapy and the prognosis in patients with esophageal carcinoma. Chin J Radiat Oncol. 2003;25(3):278–81.
16.
go back to reference Walsh TN, Noonan N, Hollywood D, Kelly A, Keeling N, Hennessy TP. A comparison of multimodal therapy and surgery for esophageal adenocarcinoma. N Engl J Med. 1996;335(7):462–7.PubMedCrossRef Walsh TN, Noonan N, Hollywood D, Kelly A, Keeling N, Hennessy TP. A comparison of multimodal therapy and surgery for esophageal adenocarcinoma. N Engl J Med. 1996;335(7):462–7.PubMedCrossRef
17.
go back to reference Bosset JF, Gignoux M, Triboulet JP, Tiret E, Mantion G, Elias D, et al. Chemoradiotherapy followed by surgery compared with surgery alone in squamous-cell cancer of the esophagus. N Engl J Med. 1997;337(3):161–7.PubMedCrossRef Bosset JF, Gignoux M, Triboulet JP, Tiret E, Mantion G, Elias D, et al. Chemoradiotherapy followed by surgery compared with surgery alone in squamous-cell cancer of the esophagus. N Engl J Med. 1997;337(3):161–7.PubMedCrossRef
18.
go back to reference Hammoud ZT, Kesler KA, Ferguson MK, Battafarrano RJ, Bhogaraju A, Hanna N, et al. Survival outcomes of resected patients who demonstrate a pathologic complete response after neoadjuvant chemoradiation therapy for locally advanced esophageal cancer. Dis Esophagus. 2006;19(2):69–72.PubMedCrossRef Hammoud ZT, Kesler KA, Ferguson MK, Battafarrano RJ, Bhogaraju A, Hanna N, et al. Survival outcomes of resected patients who demonstrate a pathologic complete response after neoadjuvant chemoradiation therapy for locally advanced esophageal cancer. Dis Esophagus. 2006;19(2):69–72.PubMedCrossRef
19.
go back to reference Donahue JM, Nichols FC, Li Z, Schomas DA, Allen MS, Cassivi SD, et al. Complete pathologic response after neoadjuvant chemoradiotherapy for esophageal cancer is associated with enhanced survival. Ann Thorac Surg. 2009;87(2):392–8. discussion 398–399.PubMedCentralPubMedCrossRef Donahue JM, Nichols FC, Li Z, Schomas DA, Allen MS, Cassivi SD, et al. Complete pathologic response after neoadjuvant chemoradiotherapy for esophageal cancer is associated with enhanced survival. Ann Thorac Surg. 2009;87(2):392–8. discussion 398–399.PubMedCentralPubMedCrossRef
20.
go back to reference Bedenne L, Michel P, Bouche O, Milan C, Mariette C, Conroy T, et al. Chemoradiation followed by surgery compared with chemoradiation alone in squamous cancer of the esophagus: FFCD 9102. J Clin Oncol. 2007;25(10):1160–8.PubMedCrossRef Bedenne L, Michel P, Bouche O, Milan C, Mariette C, Conroy T, et al. Chemoradiation followed by surgery compared with chemoradiation alone in squamous cancer of the esophagus: FFCD 9102. J Clin Oncol. 2007;25(10):1160–8.PubMedCrossRef
21.
go back to reference Rizk NP, Seshan VE, Bains MS, Ilson DH, Minsky BD, Tang L, et al. Prognostic factors after combined modality treatment of squamous cell carcinoma of the esophagus. J Thorac Oncol. 2007;2(12):1117–23.PubMedCrossRef Rizk NP, Seshan VE, Bains MS, Ilson DH, Minsky BD, Tang L, et al. Prognostic factors after combined modality treatment of squamous cell carcinoma of the esophagus. J Thorac Oncol. 2007;2(12):1117–23.PubMedCrossRef
22.
go back to reference Cho HJ, Kim YH, Kim HR, Kim DK, Park SI, Kim JH, et al. Oncologic Outcomes According to Remnant Lymph Node Metastases in Pathologic T0 (ypT0) Esophageal Squamous Cell Carcinoma Following Prospective Neoadjuvant Therapy and Surgery. Ann Surg Oncol. 2015;22(6):1851–7. Cho HJ, Kim YH, Kim HR, Kim DK, Park SI, Kim JH, et al. Oncologic Outcomes According to Remnant Lymph Node Metastases in Pathologic T0 (ypT0) Esophageal Squamous Cell Carcinoma Following Prospective Neoadjuvant Therapy and Surgery. Ann Surg Oncol. 2015;22(6):1851–7.
23.
go back to reference Edge SB BD, Compton CC, et al.(eds): AJCC Cancer Staging Manual (ed 7). In., edn.; 2010: 103–115. Edge SB BD, Compton CC, et al.(eds): AJCC Cancer Staging Manual (ed 7). In., edn.; 2010: 103–115.
24.
go back to reference Gu Y, Swisher SG, Ajani JA, Correa AM, Hofstetter WL, Liao Z, et al. The number of lymph nodes with metastasis predicts survival in patients with esophageal or esophagogastric junction adenocarcinoma who receive preoperative chemoradiation. Cancer. 2006;106(5):1017–25.PubMedCrossRef Gu Y, Swisher SG, Ajani JA, Correa AM, Hofstetter WL, Liao Z, et al. The number of lymph nodes with metastasis predicts survival in patients with esophageal or esophagogastric junction adenocarcinoma who receive preoperative chemoradiation. Cancer. 2006;106(5):1017–25.PubMedCrossRef
Metadata
Title
Residual lymph node status is an independent prognostic factor in esophageal squamous cell Carcinoma with pathologic T0 after preoperative radiotherapy
Authors
Qifeng Wang
Shufei Yu
Zefen Xiao
Xiao Liu
Wencheng Zhang
Xun Zhang
Jie He
Kelin Sun
Ting Xu
Qinfu Feng
Zongmei Zhou
Lvhua Wang
Weibo Yin
Publication date
01-12-2015
Publisher
BioMed Central
Published in
Radiation Oncology / Issue 1/2015
Electronic ISSN: 1748-717X
DOI
https://doi.org/10.1186/s13014-015-0450-4

Other articles of this Issue 1/2015

Radiation Oncology 1/2015 Go to the issue