Neoadjuvant chemoradiotherapy for esophageal cancer: Impact on extracapsular lymph node involvement

Table 1 Demographic data of 298 patients with advanced esophageal cancer n (%)

Variables	Surgery alone	NeoadjuvantCRT	Significance
Patients	108	190
Sex			NS
Male	86 (80.0)	151 (79.4)
Female	22 (20.0)	39 (20.6)
Age (yr)	63.6	60.1	P < 0.01
< 50	11 (10.2)	38 (20.0)
50-70	65 (60.2)	124 (65.3)
> 70	32 (29.6)	18 (14.7)
Histological subtype			0.871
Squamous cell carcinoma	55 (51.0)	100 (52.6)
Adenocarcinoma	53 (49.0)	90 (47.4)
No. of resected LNs (median, range)	30 (3-74)	27 (4-55)	P = 0.007
pN category			P < 0.001
pN0	27 (25.0)	98 (51.6)
pN1	81 (75.0)	92 (48.5)
LN ratio			P < 0.001
pN0	27 (25.0)	98 (51.6)
LN ratio < 0.2	52 (48.1)	69 (36.3)
LN ratio ≥ 0.2	29 (26.9)	23 (12.1)
pM1 organ	11 (10.1)	8 (4.2)	NS
R category			NS
R0	98 (92.6)	179 (94.2)
R1/R2	10 (7.4)	11 (5.8)
Response after neoadjuvant therapy
Minor response	-	112 (59.0)
Major response	-	78 (41.0)

LN: Lymph node; CRT: Chemoradiotherapy; NS: Not significant.

Table 2 Univariate survival analysis of 298 patients with advanced esophageal cancer

Variables	P	Surgery alone		Neoadjuvant CRT
		n	5-yr survival (%)	n	5-yr survival (%)
Patients	NS	108	20.4	190	25.6
Sex
Male	NS	86	22.0	151	24.4
Female	NS	22	13.8	39	32.6
Age (yr)
< 50	NS	11	58.3	38	33.7
50-70	0.015	65	15.8	124	24.7
> 70	NS	32	15.1	18	0.0
Histological subtype
Squamous cell carcinoma	NS	55	31.3	100	19.8
Adenocarcinoma	0.030	53	16.9	90	35.4
pN category
pN0	NS	27	36.5	98	41.6
pN1	NS	81	15.4	92	12.3
LN ratio
pN0	NS	27	36.5	98	41.6
LN ratio < 0.2	NS	52	23.7	69	10.3
LN ratio ≥ 0.2	NS	29	0.0	23	0.0
pM1 organ	NS	11	0.0	8	0.0
R category
R0	NS	98	22.1	179	26.4
R1/R2	NS	10	0.0	11	0.0
Response after neoadjuvant therapy
Minor response		-		112	11.4
Major response		-		78	42.4

Table 3 Influence of neoadjuvant CRT on extent of LN metastases and extracapsular LNI n (%)

T3/4 Category only(n = 298)	Surgery alone		Neoadjuvant CRT		Surgery vs neoadjuvant CRT
	Total	pN1 caps (+)	Total	pN1 caps (+)	Total	pN1 caps (+)
Total	108 (100.0)	45 (41.7)	190 (100.0)	43 (22.6)		P < 0.001
pN0M0	27 (25.0)	-	98 (51.6)	-	P < 0.001
pN1M0 caps (-)	28 (27.8)	-	38 (20.0)	-	NS
pN1M0 caps (+)	19 (17.6)	19 (100)	32 (16.8)	32 (100.0)	NS
pM1 lymph	23 (21.6)	18 (78.3)	14 (7.4)	8 (57.1)	P < 0.001	NS
pM1 organ	11 (10.1)	8 (72.7)	8 (4.2)	3 (37.5)	NS	NS

LNI: Lymph node involvement; Caps (-): Without extracapsular LNI; Caps (+): With extracapsular LNI.

Table 4 Multivariate analysis of prognostic factors for patients with neoadjuvant CRT

Variable	HR	95% CI	P
Age	1.00	0.99-1.03	0.376
Sex			0.353
Male	1 (ref)
Female	0.77	0.44-1.34
pN/pM category			0.000
pN0/pM0	1 (ref)
pN1 (-)/pM0	1.89	1.10-3.22	0.021
pN1 (+)/pM0	2.70	1.57-4.64	0.000
pM1 lymph	2.92	1.49-5.74	0.002
pM1 organ	3.92	1.76-8.72	0.001
Histology			0.145
Squamous cell carcinoma	1 (ref)
Adenocarcinoma	0.73	0.48-1.11
Response			0.010
Minor response	1 (ref)
Major response	0.56	0.36-0.87

pN1 (-): pN1 category without extracapsular LNI; pN1 (+): pN1 category with extracapsular LNI.