Metzger R, Bollschweiler E, Drebber U, Mönig SP, Schröder W, Alakus H, Kocher M, Baldus SE, Hölscher AH. Neoadjuvant chemoradiotherapy for esophageal cancer: Impact on extracapsular lymph node involvement. World J Gastroenterol 2010; 16(16): 1986-1992 [PMID: 20419835 DOI: 10.3748/wjg.v16.i16.1986]
Corresponding Author of This Article
Ralf Metzger, MD, Department of General, Visceral and Cancer Surgery, Center for Integrated Oncology, University Hospital of Cologne, Kerpener Str. 62, 50937 Cologne, Germany. ralf.metzger@uk-koeln.de
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World J Gastroenterol. Apr 28, 2010; 16(16): 1986-1992 Published online Apr 28, 2010. doi: 10.3748/wjg.v16.i16.1986
Neoadjuvant chemoradiotherapy for esophageal cancer: Impact on extracapsular lymph node involvement
Ralf Metzger, Elfriede Bollschweiler, Uta Drebber, Stefan P Mönig, Wolfgang Schröder, Hakan Alakus, Martin Kocher, Stephan E Baldus, Arnulf H Hölscher
Ralf Metzger, Elfriede Bollschweiler, Stefan P Mönig, Wolfgang Schröder, Hakan Alakus, Arnulf H Hölscher, Department of General, Visceral and Cancer Surgery, Center for Integrated Oncology, University Hospital of Cologne, 50937 Cologne, Germany
Uta Drebber, Department of Pathology, University of Cologne, 50937 Cologne, Germany
Martin Kocher, Department of Radiation Oncology, University of Cologne, 50937 Cologne, Germany
Stephan E Baldus, Department of Pathology, University of Düsseldorf, 40225 Düsseldorf, Germany
Author contributions: Metzger R was involved in the majority of writing and editing of the manuscript, and coordinating the study; Bollschweiler E performed the statistical analysis and contributed to the conception and design of the manuscript; Drebber U and Baldus SE were responsible for pathological assessment of the resected tumor samples and lymph nodes; Mönig SP and Schröder W contributed to the acquisition of surgical and routine histopathological data; Alakus H was involved in the acquisition of the surgical data and in editing the manuscript; Kocher M performed the neoadjuvant chemoradiotherapy; Hölscher AH coordinated and performed the study and edited the manuscript.
Supported by Department of General, Visceral and Cancer Surgery, Center for Integrated Oncology (CIO) Köln Bonn and the Hoff`sche Stiftung
Correspondence to: Ralf Metzger, MD, Department of General, Visceral and Cancer Surgery, Center for Integrated Oncology, University Hospital of Cologne, Kerpener Str. 62, 50937 Cologne, Germany. ralf.metzger@uk-koeln.de
Telephone: +49-221-4784803 Fax: +49-221-4786258
Received: December 21, 2009 Revised: January 21, 2010 Accepted: January 28, 2010 Published online: April 28, 2010
Abstract
AIM: To assess the effects of neoadjuvant chemoradiotherapy (CRT) on the presence of extracapsular lymph node involvement (LNI) and its prognostic value in patients with resected esophageal cancer.
METHODS: Two hundred and ninety-eight patients with advanced esophageal cancer underwent esophagectomy between 1997 and 2006. One hundred and ninety patients (63.8%) were treated with neoadjuvant CRT prior to resection. A total of 986 metastatic LNs were examined. Survival of the patients was analyzed according to intra- and extra-capsular LNI.
RESULTS: Five-year survival rate was 22.5% for the entire patient population. Patients with extracapsular LNI had a 5-year survival rate of 16.7%, which was comparable to the 15.8% in patients with infiltrated nodes of the celiac trunk (pM1lymph). In contrast to patients treated with surgery alone, neoadjuvant therapy resulted in significantly (P = 0.001) more patients with pN0/M0 (51.6% vs 25.0%). In 17.6% of the patients with surgery alone vs 16.8% with neoadjuvant CRT, extracapsular LNI was detected. Neoadjuvant therapy does not reduce the occurrence of extracapsular LNI.
CONCLUSION: Extracapsular LNI is an independent negative prognostic factor not influenced by neoadjuvant CRT. In a revised staging system for esophageal cancer, extracapsular LNI should be considered.
