Clinical lymph node staging and impact on different treatment options in esophageal cancer

Dijksterhuis, W.P.M. (2017) Clinical lymph node staging and impact on different treatment options in esophageal cancer. thesis, Medicine.

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Abstract

Background: Accurate clinical nodal (cN) staging in esophageal cancer (EC) remains difficult. Prognostic impact of nodal over- and downstaging on 5-year disease-free survival (DFS) and predictability of response were assessed in EC patients after surgery alone or after neoadjuvant chemoradiotherapy (nCRT) followed by surgery. Patients and methods: From a prospectively maintained database, we included 395 consecutive patients with curative intended esophagectomy after or without nCRT between 2000 and 2015. Propensity score matching was performed on clinical tumor (cT) and nodal stage, and histopathological tumor type. All patients (n=270) received a PET and CT or PET-CT, and endoscopic ultrasonography (n=235). Agreement of clinical (cN) and pathological N-stage (pN) was scored as correct (cNstage=pNstage), downstaging (cNstage>pNstage) and upstaging (cNstage<pNstage). Prognostic value of nodal up- and downstaging and site-specific lymph node metastases on 5-year DFS were assessed with multivariate Cox regression analysis (P-value<0.1 on univariate analysis). Results: The surgery-alone and nCRT group differed (P<0.001) in pertaining nodal upstaging (43.0% vs. 16.3%), correct staging (31.9% vs. 28.1%) and downstaging (25.2% vs. 55.6%), respectively. Nodal upstaging was common in adenocarcinoma and cT3/T4a tumors. Prognostic independent for 5- year DFS were pN (P=0.002) and lymph-angioinvasion (P=0.016), and upper abdominal cN metastases (P=0.012) and lymph node ratio (P=0.034) in the surgery-alone and nCRT group, respectively. Conclusions: Clinical node staging remains inaccurate with approximately 40% over- and 25% downstaging in surgery-alone patients, which impedes (re)assessment of true nodal response to nCRT. Furthermore, it evokes questions in decision making for a ‘wait-and-see’strategy (esophageal preservation) in clinical complete responders to nCRT.

Item Type:	Thesis (Thesis)
Supervisor name:	Supervisor: and Plukker, Prof. J.T.M. and Dept. of Surgical Oncology and University Medical center Groningen
Faculty:	Medical Sciences
Date Deposited:	25 Jun 2020 10:54
Last Modified:	25 Jun 2020 10:54
URI:	https://umcg.studenttheses.ub.rug.nl/id/eprint/1518

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