Prognostic Impact of Postoperative Lymph Node Metastases After Neoadjuvant Chemoradiotherapy for Locally Advanced Squamous Cell Carcinoma of Esophagus: From the Results of NEOCRTEC5010, a Randomized Multicenter Study
OBJECTIVE:To determine the prognostic impact of pathologic lymph node (LN) status and investigate risk factors of recurrence in esophageal squamous cell carcinoma (ESCC) patients with pathologic complete response (pCR) after neoadjuvant chemoradiotherapy (NCRT). SUMMARY BACKGROUND DATA:There are no...
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| Veröffentlicht in: | Annals of surgery 2021-12, Vol.274 (6), p.e1022-e1029 |
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| creator | Leng, Xuefeng He, Wenwu Yang, Hong Chen, Yuping Zhu, Chengchu Fang, Wentao Yu, Zhentao Mao, Weimin Xiang, Jiaqing Chen, Zhijian Yang, Haihua Wang, Jiaming Pang, Qingsong Zheng, Xiao Liu, Hui Yang, Huanjun Li, Tao Zhang, Xu Li, Qun Wang, Geng Mao, Teng Guo, Xufeng Lin, Ting Liu, Mengzhong Fu, Jianhua Han, Yongtao |
| description | OBJECTIVE:To determine the prognostic impact of pathologic lymph node (LN) status and investigate risk factors of recurrence in esophageal squamous cell carcinoma (ESCC) patients with pathologic complete response (pCR) after neoadjuvant chemoradiotherapy (NCRT).
SUMMARY BACKGROUND DATA:There are no large-scale prospective study data regarding ypN status and recurrence after pCR in ESCC patients receiving NCRT.
METHODS:The NEOCRTEC5010 trial was a prospective multicenter trial that compared the survival and safety of NCRT plus surgery (S) with S in patients with locally advanced ESCC. The relationships between survival and cN, pN, and ypN status were assessed. Potential prognostic factors in patients with ypN+ and pCR were identified.
RESULTS:A total of 389 ESCC patients (NCRT182; S207) were included. Patients with pN+ in the S group and ypN+ in the NCRT group had decreased overall survival (OS) and disease-free survival (DFS) compared with pN0 and ypN0 patients, respectively. Partial response at the primary site [hazard ratio (HR), 2.09] and stable disease in the LNs (HR, 3.26) were independent risk factors for lower DFS, but not OS. For patients with pCR, the recurrence rate was 13.9%. Patients with distant LN metastasis had a median OS and DFS of 16.1 months and 14.4 months, respectively. Failure to achieve the median total dose of chemotherapy was a significant risk factor of recurrence and metastasis after pCR (HR, 44.27).
CONCLUSIONS:Persistent pathologic LN metastasis after NCRT is a strong poor prognostic factor in ESCC. Additionally, pCR does not guarantee a cure; patients with pCR should undergo an active strategy of surveillance and adjuvant therapy. |
| doi_str_mv | 10.1097/SLA.0000000000003727 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_webof</sourceid><recordid>TN_cdi_webofscience_primary_000718532600365</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2329741631</sourcerecordid><originalsourceid>FETCH-LOGICAL-c3507-633f5adbc192a8f6468ea97932a1ee1da7d2966ee7962fcb767e0d81bee159e13</originalsourceid><addsrcrecordid>eNqNkt9u0zAUxiPExMrgDRDyJdLI8J_ETrirog4mdd3UjuvItU-WjCTObGdTeVIeB4du08QFYFmybP--7_ic4yh6R_AJwbn4tFnOT_CzwQQVL6IZSWkWE5Lgl9FsOo2TnNHD6LVzNxiTJMPiVXTISJammUhn0c9La65743yj0Fk3SOWRqdBlODADWOmbO0DLXTfUaGU0oHPw0oUJDs0rDxatwEh9M97J3qOihs5YqRvj66AddqgyFi2Nkm27Q3MdIAUabW5H2ZnRoQLaFhXSqqY3nZziLpwZank9us_o1JoOBR-0Bje23k3Xq8VFsb5aFCkm-COSaC17bbrmRzA9D0yjoJ_etPGj3r2JDirZOnj7sB5F304XV8XXeHnx5ayYL2PFUixizliVSr1VJKcyq3jCM5C5CDWTBIBoKTTNOQcQOaeV2gouAOuMbMNlmgNhR9GHve9gze0Izpdd41TITPYQkiwpo7lICGcTmuxRZY1zFqpysE0n7a4kuJx6Woaeln_2NMjeP0QYtx3oJ9FjEwNwvAfuYWsqpxoIdX7Cgo0IJKM8-PGJzv6fLhof_oDpCzP2_pnUtKHQ7ns73oMta5Ctr_-VRPIX6W-Op1lMMSWEhk0cdHnGfgFw6uGR</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2329741631</pqid></control><display><type>article</type><title>Prognostic Impact of Postoperative Lymph Node Metastases After Neoadjuvant Chemoradiotherapy for Locally Advanced Squamous Cell Carcinoma of Esophagus: From the Results of NEOCRTEC5010, a Randomized Multicenter Study</title><source>MEDLINE</source><source>Journals@Ovid Complete</source><source>PubMed Central</source><creator>Leng, Xuefeng ; He, Wenwu ; Yang, Hong ; Chen, Yuping ; Zhu, Chengchu ; Fang, Wentao ; Yu, Zhentao ; Mao, Weimin ; Xiang, Jiaqing ; Chen, Zhijian ; Yang, Haihua ; Wang, Jiaming ; Pang, Qingsong ; Zheng, Xiao ; Liu, Hui ; Yang, Huanjun ; Li, Tao ; Zhang, Xu ; Li, Qun ; Wang, Geng ; Mao, Teng ; Guo, Xufeng ; Lin, Ting ; Liu, Mengzhong ; Fu, Jianhua ; Han, Yongtao</creator><creatorcontrib>Leng, Xuefeng ; He, Wenwu ; Yang, Hong ; Chen, Yuping ; Zhu, Chengchu ; Fang, Wentao ; Yu, Zhentao ; Mao, Weimin ; Xiang, Jiaqing ; Chen, Zhijian ; Yang, Haihua ; Wang, Jiaming ; Pang, Qingsong ; Zheng, Xiao ; Liu, Hui ; Yang, Huanjun ; Li, Tao ; Zhang, Xu ; Li, Qun ; Wang, Geng ; Mao, Teng ; Guo, Xufeng ; Lin, Ting ; Liu, Mengzhong ; Fu, Jianhua ; Han, Yongtao</creatorcontrib><description>OBJECTIVE:To determine the prognostic impact of pathologic lymph node (LN) status and investigate risk factors of recurrence in esophageal squamous cell carcinoma (ESCC) patients with pathologic complete response (pCR) after neoadjuvant chemoradiotherapy (NCRT).
SUMMARY BACKGROUND DATA:There are no large-scale prospective study data regarding ypN status and recurrence after pCR in ESCC patients receiving NCRT.
METHODS:The NEOCRTEC5010 trial was a prospective multicenter trial that compared the survival and safety of NCRT plus surgery (S) with S in patients with locally advanced ESCC. The relationships between survival and cN, pN, and ypN status were assessed. Potential prognostic factors in patients with ypN+ and pCR were identified.
RESULTS:A total of 389 ESCC patients (NCRT182; S207) were included. Patients with pN+ in the S group and ypN+ in the NCRT group had decreased overall survival (OS) and disease-free survival (DFS) compared with pN0 and ypN0 patients, respectively. Partial response at the primary site [hazard ratio (HR), 2.09] and stable disease in the LNs (HR, 3.26) were independent risk factors for lower DFS, but not OS. For patients with pCR, the recurrence rate was 13.9%. Patients with distant LN metastasis had a median OS and DFS of 16.1 months and 14.4 months, respectively. Failure to achieve the median total dose of chemotherapy was a significant risk factor of recurrence and metastasis after pCR (HR, 44.27).
CONCLUSIONS:Persistent pathologic LN metastasis after NCRT is a strong poor prognostic factor in ESCC. Additionally, pCR does not guarantee a cure; patients with pCR should undergo an active strategy of surveillance and adjuvant therapy.</description><identifier>ISSN: 0003-4932</identifier><identifier>EISSN: 1528-1140</identifier><identifier>DOI: 10.1097/SLA.0000000000003727</identifier><identifier>PMID: 31855875</identifier><language>eng</language><publisher>PHILADELPHIA: Lippincott Williams & Wilkins</publisher><subject>Adult ; Aged ; Carcinoma, Squamous Cell - pathology ; Carcinoma, Squamous Cell - therapy ; Chemoradiotherapy ; Chemoradiotherapy, Adjuvant ; Combined Modality Therapy ; Esophageal Neoplasms - pathology ; Esophageal Neoplasms - therapy ; Esophagectomy ; Female ; Humans ; Life Sciences & Biomedicine ; Lymph Node Excision ; Lymphatic Metastasis ; Male ; Middle Aged ; Neoadjuvant Therapy ; Neoplasm Recurrence, Local ; Neoplasm Staging ; Prognosis ; Prospective Studies ; Risk Factors ; Science & Technology ; Surgery ; Survival Rate</subject><ispartof>Annals of surgery, 2021-12, Vol.274 (6), p.e1022-e1029</ispartof><rights>Lippincott Williams & Wilkins</rights><rights>Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>true</woscitedreferencessubscribed><woscitedreferencescount>53</woscitedreferencescount><woscitedreferencesoriginalsourcerecordid>wos000718532600365</woscitedreferencesoriginalsourcerecordid><cites>FETCH-LOGICAL-c3507-633f5adbc192a8f6468ea97932a1ee1da7d2966ee7962fcb767e0d81bee159e13</cites><orcidid>0000-0001-5549-8633 ; 0000-0002-5897-0419 ; 0000-0002-8451-3705 ; 0000-0002-1086-4852</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>315,781,785,27928,27929</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/31855875$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Leng, Xuefeng</creatorcontrib><creatorcontrib>He, Wenwu</creatorcontrib><creatorcontrib>Yang, Hong</creatorcontrib><creatorcontrib>Chen, Yuping</creatorcontrib><creatorcontrib>Zhu, Chengchu</creatorcontrib><creatorcontrib>Fang, Wentao</creatorcontrib><creatorcontrib>Yu, Zhentao</creatorcontrib><creatorcontrib>Mao, Weimin</creatorcontrib><creatorcontrib>Xiang, Jiaqing</creatorcontrib><creatorcontrib>Chen, Zhijian</creatorcontrib><creatorcontrib>Yang, Haihua</creatorcontrib><creatorcontrib>Wang, Jiaming</creatorcontrib><creatorcontrib>Pang, Qingsong</creatorcontrib><creatorcontrib>Zheng, Xiao</creatorcontrib><creatorcontrib>Liu, Hui</creatorcontrib><creatorcontrib>Yang, Huanjun</creatorcontrib><creatorcontrib>Li, Tao</creatorcontrib><creatorcontrib>Zhang, Xu</creatorcontrib><creatorcontrib>Li, Qun</creatorcontrib><creatorcontrib>Wang, Geng</creatorcontrib><creatorcontrib>Mao, Teng</creatorcontrib><creatorcontrib>Guo, Xufeng</creatorcontrib><creatorcontrib>Lin, Ting</creatorcontrib><creatorcontrib>Liu, Mengzhong</creatorcontrib><creatorcontrib>Fu, Jianhua</creatorcontrib><creatorcontrib>Han, Yongtao</creatorcontrib><title>Prognostic Impact of Postoperative Lymph Node Metastases After Neoadjuvant Chemoradiotherapy for Locally Advanced Squamous Cell Carcinoma of Esophagus: From the Results of NEOCRTEC5010, a Randomized Multicenter Study</title><title>Annals of surgery</title><addtitle>ANN SURG</addtitle><addtitle>Ann Surg</addtitle><description>OBJECTIVE:To determine the prognostic impact of pathologic lymph node (LN) status and investigate risk factors of recurrence in esophageal squamous cell carcinoma (ESCC) patients with pathologic complete response (pCR) after neoadjuvant chemoradiotherapy (NCRT).
SUMMARY BACKGROUND DATA:There are no large-scale prospective study data regarding ypN status and recurrence after pCR in ESCC patients receiving NCRT.
METHODS:The NEOCRTEC5010 trial was a prospective multicenter trial that compared the survival and safety of NCRT plus surgery (S) with S in patients with locally advanced ESCC. The relationships between survival and cN, pN, and ypN status were assessed. Potential prognostic factors in patients with ypN+ and pCR were identified.
RESULTS:A total of 389 ESCC patients (NCRT182; S207) were included. Patients with pN+ in the S group and ypN+ in the NCRT group had decreased overall survival (OS) and disease-free survival (DFS) compared with pN0 and ypN0 patients, respectively. Partial response at the primary site [hazard ratio (HR), 2.09] and stable disease in the LNs (HR, 3.26) were independent risk factors for lower DFS, but not OS. For patients with pCR, the recurrence rate was 13.9%. Patients with distant LN metastasis had a median OS and DFS of 16.1 months and 14.4 months, respectively. Failure to achieve the median total dose of chemotherapy was a significant risk factor of recurrence and metastasis after pCR (HR, 44.27).
CONCLUSIONS:Persistent pathologic LN metastasis after NCRT is a strong poor prognostic factor in ESCC. Additionally, pCR does not guarantee a cure; patients with pCR should undergo an active strategy of surveillance and adjuvant therapy.</description><subject>Adult</subject><subject>Aged</subject><subject>Carcinoma, Squamous Cell - pathology</subject><subject>Carcinoma, Squamous Cell - therapy</subject><subject>Chemoradiotherapy</subject><subject>Chemoradiotherapy, Adjuvant</subject><subject>Combined Modality Therapy</subject><subject>Esophageal Neoplasms - pathology</subject><subject>Esophageal Neoplasms - therapy</subject><subject>Esophagectomy</subject><subject>Female</subject><subject>Humans</subject><subject>Life Sciences & Biomedicine</subject><subject>Lymph Node Excision</subject><subject>Lymphatic Metastasis</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Neoadjuvant Therapy</subject><subject>Neoplasm Recurrence, Local</subject><subject>Neoplasm Staging</subject><subject>Prognosis</subject><subject>Prospective Studies</subject><subject>Risk Factors</subject><subject>Science & Technology</subject><subject>Surgery</subject><subject>Survival Rate</subject><issn>0003-4932</issn><issn>1528-1140</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2021</creationdate><recordtype>article</recordtype><sourceid>HGBXW</sourceid><sourceid>EIF</sourceid><recordid>eNqNkt9u0zAUxiPExMrgDRDyJdLI8J_ETrirog4mdd3UjuvItU-WjCTObGdTeVIeB4du08QFYFmybP--7_ic4yh6R_AJwbn4tFnOT_CzwQQVL6IZSWkWE5Lgl9FsOo2TnNHD6LVzNxiTJMPiVXTISJammUhn0c9La65743yj0Fk3SOWRqdBlODADWOmbO0DLXTfUaGU0oHPw0oUJDs0rDxatwEh9M97J3qOihs5YqRvj66AddqgyFi2Nkm27Q3MdIAUabW5H2ZnRoQLaFhXSqqY3nZziLpwZank9us_o1JoOBR-0Bje23k3Xq8VFsb5aFCkm-COSaC17bbrmRzA9D0yjoJ_etPGj3r2JDirZOnj7sB5F304XV8XXeHnx5ayYL2PFUixizliVSr1VJKcyq3jCM5C5CDWTBIBoKTTNOQcQOaeV2gouAOuMbMNlmgNhR9GHve9gze0Izpdd41TITPYQkiwpo7lICGcTmuxRZY1zFqpysE0n7a4kuJx6Woaeln_2NMjeP0QYtx3oJ9FjEwNwvAfuYWsqpxoIdX7Cgo0IJKM8-PGJzv6fLhof_oDpCzP2_pnUtKHQ7ns73oMta5Ctr_-VRPIX6W-Op1lMMSWEhk0cdHnGfgFw6uGR</recordid><startdate>20211201</startdate><enddate>20211201</enddate><creator>Leng, Xuefeng</creator><creator>He, Wenwu</creator><creator>Yang, Hong</creator><creator>Chen, Yuping</creator><creator>Zhu, Chengchu</creator><creator>Fang, Wentao</creator><creator>Yu, Zhentao</creator><creator>Mao, Weimin</creator><creator>Xiang, Jiaqing</creator><creator>Chen, Zhijian</creator><creator>Yang, Haihua</creator><creator>Wang, Jiaming</creator><creator>Pang, Qingsong</creator><creator>Zheng, Xiao</creator><creator>Liu, Hui</creator><creator>Yang, Huanjun</creator><creator>Li, Tao</creator><creator>Zhang, Xu</creator><creator>Li, Qun</creator><creator>Wang, Geng</creator><creator>Mao, Teng</creator><creator>Guo, Xufeng</creator><creator>Lin, Ting</creator><creator>Liu, Mengzhong</creator><creator>Fu, Jianhua</creator><creator>Han, Yongtao</creator><general>Lippincott Williams & Wilkins</general><general>Copyright Wolters Kluwer Health, Inc. All rights reserved</general><scope>BLEPL</scope><scope>DTL</scope><scope>HGBXW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0001-5549-8633</orcidid><orcidid>https://orcid.org/0000-0002-5897-0419</orcidid><orcidid>https://orcid.org/0000-0002-8451-3705</orcidid><orcidid>https://orcid.org/0000-0002-1086-4852</orcidid></search><sort><creationdate>20211201</creationdate><title>Prognostic Impact of Postoperative Lymph Node Metastases After Neoadjuvant Chemoradiotherapy for Locally Advanced Squamous Cell Carcinoma of Esophagus: From the Results of NEOCRTEC5010, a Randomized Multicenter Study</title><author>Leng, Xuefeng ; He, Wenwu ; Yang, Hong ; Chen, Yuping ; Zhu, Chengchu ; Fang, Wentao ; Yu, Zhentao ; Mao, Weimin ; Xiang, Jiaqing ; Chen, Zhijian ; Yang, Haihua ; Wang, Jiaming ; Pang, Qingsong ; Zheng, Xiao ; Liu, Hui ; Yang, Huanjun ; Li, Tao ; Zhang, Xu ; Li, Qun ; Wang, Geng ; Mao, Teng ; Guo, Xufeng ; Lin, Ting ; Liu, Mengzhong ; Fu, Jianhua ; Han, Yongtao</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c3507-633f5adbc192a8f6468ea97932a1ee1da7d2966ee7962fcb767e0d81bee159e13</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2021</creationdate><topic>Adult</topic><topic>Aged</topic><topic>Carcinoma, Squamous Cell - pathology</topic><topic>Carcinoma, Squamous Cell - therapy</topic><topic>Chemoradiotherapy</topic><topic>Chemoradiotherapy, Adjuvant</topic><topic>Combined Modality Therapy</topic><topic>Esophageal Neoplasms - pathology</topic><topic>Esophageal Neoplasms - therapy</topic><topic>Esophagectomy</topic><topic>Female</topic><topic>Humans</topic><topic>Life Sciences & Biomedicine</topic><topic>Lymph Node Excision</topic><topic>Lymphatic Metastasis</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Neoadjuvant Therapy</topic><topic>Neoplasm Recurrence, Local</topic><topic>Neoplasm Staging</topic><topic>Prognosis</topic><topic>Prospective Studies</topic><topic>Risk Factors</topic><topic>Science & Technology</topic><topic>Surgery</topic><topic>Survival Rate</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Leng, Xuefeng</creatorcontrib><creatorcontrib>He, Wenwu</creatorcontrib><creatorcontrib>Yang, Hong</creatorcontrib><creatorcontrib>Chen, Yuping</creatorcontrib><creatorcontrib>Zhu, Chengchu</creatorcontrib><creatorcontrib>Fang, Wentao</creatorcontrib><creatorcontrib>Yu, Zhentao</creatorcontrib><creatorcontrib>Mao, Weimin</creatorcontrib><creatorcontrib>Xiang, Jiaqing</creatorcontrib><creatorcontrib>Chen, Zhijian</creatorcontrib><creatorcontrib>Yang, Haihua</creatorcontrib><creatorcontrib>Wang, Jiaming</creatorcontrib><creatorcontrib>Pang, Qingsong</creatorcontrib><creatorcontrib>Zheng, Xiao</creatorcontrib><creatorcontrib>Liu, Hui</creatorcontrib><creatorcontrib>Yang, Huanjun</creatorcontrib><creatorcontrib>Li, Tao</creatorcontrib><creatorcontrib>Zhang, Xu</creatorcontrib><creatorcontrib>Li, Qun</creatorcontrib><creatorcontrib>Wang, Geng</creatorcontrib><creatorcontrib>Mao, Teng</creatorcontrib><creatorcontrib>Guo, Xufeng</creatorcontrib><creatorcontrib>Lin, Ting</creatorcontrib><creatorcontrib>Liu, Mengzhong</creatorcontrib><creatorcontrib>Fu, Jianhua</creatorcontrib><creatorcontrib>Han, Yongtao</creatorcontrib><collection>Web of Science Core Collection</collection><collection>Science Citation Index Expanded</collection><collection>Web of Science - Science Citation Index Expanded - 2021</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Annals of surgery</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Leng, Xuefeng</au><au>He, Wenwu</au><au>Yang, Hong</au><au>Chen, Yuping</au><au>Zhu, Chengchu</au><au>Fang, Wentao</au><au>Yu, Zhentao</au><au>Mao, Weimin</au><au>Xiang, Jiaqing</au><au>Chen, Zhijian</au><au>Yang, Haihua</au><au>Wang, Jiaming</au><au>Pang, Qingsong</au><au>Zheng, Xiao</au><au>Liu, Hui</au><au>Yang, Huanjun</au><au>Li, Tao</au><au>Zhang, Xu</au><au>Li, Qun</au><au>Wang, Geng</au><au>Mao, Teng</au><au>Guo, Xufeng</au><au>Lin, Ting</au><au>Liu, Mengzhong</au><au>Fu, Jianhua</au><au>Han, Yongtao</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Prognostic Impact of Postoperative Lymph Node Metastases After Neoadjuvant Chemoradiotherapy for Locally Advanced Squamous Cell Carcinoma of Esophagus: From the Results of NEOCRTEC5010, a Randomized Multicenter Study</atitle><jtitle>Annals of surgery</jtitle><stitle>ANN SURG</stitle><addtitle>Ann Surg</addtitle><date>2021-12-01</date><risdate>2021</risdate><volume>274</volume><issue>6</issue><spage>e1022</spage><epage>e1029</epage><pages>e1022-e1029</pages><issn>0003-4932</issn><eissn>1528-1140</eissn><abstract>OBJECTIVE:To determine the prognostic impact of pathologic lymph node (LN) status and investigate risk factors of recurrence in esophageal squamous cell carcinoma (ESCC) patients with pathologic complete response (pCR) after neoadjuvant chemoradiotherapy (NCRT).
SUMMARY BACKGROUND DATA:There are no large-scale prospective study data regarding ypN status and recurrence after pCR in ESCC patients receiving NCRT.
METHODS:The NEOCRTEC5010 trial was a prospective multicenter trial that compared the survival and safety of NCRT plus surgery (S) with S in patients with locally advanced ESCC. The relationships between survival and cN, pN, and ypN status were assessed. Potential prognostic factors in patients with ypN+ and pCR were identified.
RESULTS:A total of 389 ESCC patients (NCRT182; S207) were included. Patients with pN+ in the S group and ypN+ in the NCRT group had decreased overall survival (OS) and disease-free survival (DFS) compared with pN0 and ypN0 patients, respectively. Partial response at the primary site [hazard ratio (HR), 2.09] and stable disease in the LNs (HR, 3.26) were independent risk factors for lower DFS, but not OS. For patients with pCR, the recurrence rate was 13.9%. Patients with distant LN metastasis had a median OS and DFS of 16.1 months and 14.4 months, respectively. Failure to achieve the median total dose of chemotherapy was a significant risk factor of recurrence and metastasis after pCR (HR, 44.27).
CONCLUSIONS:Persistent pathologic LN metastasis after NCRT is a strong poor prognostic factor in ESCC. Additionally, pCR does not guarantee a cure; patients with pCR should undergo an active strategy of surveillance and adjuvant therapy.</abstract><cop>PHILADELPHIA</cop><pub>Lippincott Williams & Wilkins</pub><pmid>31855875</pmid><doi>10.1097/SLA.0000000000003727</doi><tpages>8</tpages><orcidid>https://orcid.org/0000-0001-5549-8633</orcidid><orcidid>https://orcid.org/0000-0002-5897-0419</orcidid><orcidid>https://orcid.org/0000-0002-8451-3705</orcidid><orcidid>https://orcid.org/0000-0002-1086-4852</orcidid></addata></record> |
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| ispartof | Annals of surgery, 2021-12, Vol.274 (6), p.e1022-e1029 |
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| source | MEDLINE; Journals@Ovid Complete; PubMed Central |
| subjects | Adult Aged Carcinoma, Squamous Cell - pathology Carcinoma, Squamous Cell - therapy Chemoradiotherapy Chemoradiotherapy, Adjuvant Combined Modality Therapy Esophageal Neoplasms - pathology Esophageal Neoplasms - therapy Esophagectomy Female Humans Life Sciences & Biomedicine Lymph Node Excision Lymphatic Metastasis Male Middle Aged Neoadjuvant Therapy Neoplasm Recurrence, Local Neoplasm Staging Prognosis Prospective Studies Risk Factors Science & Technology Surgery Survival Rate |
| title | Prognostic Impact of Postoperative Lymph Node Metastases After Neoadjuvant Chemoradiotherapy for Locally Advanced Squamous Cell Carcinoma of Esophagus: From the Results of NEOCRTEC5010, a Randomized Multicenter Study |
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