Oncologic Outcomes According to Remnant Lymph Node Metastases in Pathologic T0 (ypT0) Esophageal Squamous Cell Carcinoma Following Prospective Neoadjuvant Therapy and Surgery

Abstract

Some esophageal cancer patients may have residual nodal metastases following pathologic complete response (pCR) of the primary tumor after neoadjuvant chemoradiotherapy (CRT). This study examines the prognosis according to lymph node metastases in pathologic T0 patients who received neoadjuvant CRT followed by surgery for esophageal squamous cell carcinoma (SCC). Prospectively-collected data from patients who underwent protocol-based esophageal resection and reconstruction after neoadjuvant CRT for esophageal SCC from 2000 to 2010 at the Asan Medical Center, Seoul, Korea, were retrospectively studied. Overall survival (OS), recurrence-free survival (RFS), and risk factors for ypT0N1 were analyzed and compared with ypT0N0. A total of 211 patients underwent prospective, protocol-based esophageal resection and reconstruction after neoadjuvant CRT for esophageal SCC. Of these, 123 patients had a pCR of the primary tumor and were enrolled in this study. Lymph node status was ypT0N0 in 103 patients and ypT0N1 in 20 patients. The two groups did not show significant differences in sex, initial clinical stage, tumor location, and histologic grade. Recurrence occurred in 13 patients (12.6 %) with ypT0N0 and six patients (30.0 %) with ypT0N1, respectively (p = 0.083). Five-year OS and RFS of ypT0N1 were 42.8 +/- A 13.9 and 41.7 +/- A 12.8 %, respectively. Survival was compared between the two groups using a log-rank test, and there were no significant differences for OS or RFS. Residual lymph node metastases did not significantly influence prognosis in pathologic T0 patients who received neoadjuvant CRT followed by surgery for esophageal SCC.