Sterilization of tumor-positive lymph nodes of esophageal cancer by neo-adjuvant treatment is associated with worse survival compared to tumor-negative lymph nodes treated with surgery first

J Surg Oncol. 2017 Sep;116(4):524-532. doi: 10.1002/jso.24689. Epub 2017 May 25.


Background and objectives: Lymph node (LN) involvement by esophageal cancer is associated with compromised long-term prognosis. This study assessed whether LN downstaging by neoadjuvant treatment (NAT) might offer a survival benefit compared to patients with a priori negative LN.

Methods: Patients undergoing esophagectomy for cancer between 2005 and 2014 were screened for inclusion. Group 1 included cN0 patients confirmed as pN0 who were treated with surgery first, whereas group 2 included patients initially cN+ and down-staged to ypN0 after NAT. Survival analysis was performed with the Kaplan-Meier and Cox regression methods.

Results: Fifty-seven patients were included in our study, 24 in group 1 and 33 in group 2. Group 2 patients had more locally advanced lesions compared to a priori negative patients, and despite complete LN sterilization by NAT they still had worse long-term survival. Overall 3-year survival was 86.8% for a priori LN negative versus 63.3% for downstaged patients (P = 0.013), while disease-free survival was 79.6% and 57.9%, respectively (P = 0.021). Tumor recurrence was also earlier and more disseminated for the down-staged group.

Conclusions: Downstaged LN, despite the systemic effect of NAT, still inherit an increased risk for early tumor recurrence and worse long-term survival compared to a priori negative LN.

Keywords: downstaging; esophageal cancer; esophagectomY; lymph node metastasis; neoadjuvant treatment.

MeSH terms

  • Aged
  • Chemotherapy, Adjuvant
  • Disease-Free Survival
  • Esophageal Neoplasms / mortality*
  • Esophageal Neoplasms / pathology
  • Female
  • Humans
  • Lymph Nodes / drug effects*
  • Lymph Nodes / pathology
  • Lymph Nodes / radiation effects*
  • Lymphatic Metastasis
  • Male
  • Middle Aged
  • Neoadjuvant Therapy
  • Neoplasm Recurrence, Local
  • Neoplasm Staging
  • Radiotherapy, Adjuvant