Patterns and influence of nodal metastases after neoadjuvant chemoradiation and R0 resection in esophageal adenocarcinoma Journal Article


Authors: Harrington, C. A.; Carr, R. A.; Hsu, M.; Tan, K. S.; Sihag, S.; Adusumilli, P. S.; Bains, M. S.; Bott, M. J.; Isbell, J. M.; Park, B. J.; Rocco, G.; Rusch, V. W.; Jones, D. R.; Molena, D.
Article Title: Patterns and influence of nodal metastases after neoadjuvant chemoradiation and R0 resection in esophageal adenocarcinoma
Abstract: Objective: Little is known about the pattern of nodal metastases in patients with esophageal adenocarcinoma who have received neoadjuvant chemoradiation and undergone surgery. We sought to assess this pattern and evaluate its association with prognosis. Methods: All patients with esophageal adenocarcinoma who underwent neoadjuvant chemoradiation and R0 esophagectomy between 2010 and 2018 at our institution were included (n = 537). The primary objective was to evaluate the association of sites of lymph node metastases with disease-free survival. The number of nodal stations and individual sites of nodal metastases were evaluated first in univariable then in separate multivariable Cox regression models adjusted for clinical factors. Results: Of 537 patients, 193 (36%) had pathologic nodal metastases at the time of surgery; 153 (28%) had single-station disease, 32 (6.0%) had 2-station disease, and 8 (1.5%) had 3-station disease. The majority of patients with multiple positive nodal stations had positive nodes in the paraesophageal (93%) and/or left gastric stations (60%). Multivariable models controlling for clinical factors showed that an increasing number of positive nodal stations (hazard ratio, 1.59; 95% CI, 1.35-1.84; P < .01)—in particular, the subcarinal (hazard ratio, 2.78; 95% CI, 1.54-5.03; P < .01) and paraesophageal stations (hazard ratio, 2.0; 95% CI, 1.58-2.54; P < .01)—was associated with increased risk of recurrence. Conclusions: One-third of patients who have undergone R0 resection for esophageal adenocarcinoma following induction chemoradiation therapy have metastatic lymph nodes. An increasing number of nodal stations, particularly paraesophageal and subcarinal metastases, were associated with increased risk of recurrence. © 2022 The American Association for Thoracic Surgery
Keywords: retrospective studies; neoadjuvant therapy; cancer staging; lymph nodes; neoplasm staging; adenocarcinoma; pathology; retrospective study; lymph node; surgery; esophageal adenocarcinoma; esophagus tumor; esophageal neoplasms; esophagectomy; adverse event; nodal metastases; neoadjuvant chemoradiation; humans; prognosis; human
Journal Title: Journal of Thoracic and Cardiovascular Surgery
Volume: 164
Issue: 2
ISSN: 0022-5223
Publisher: Mosby Elsevier  
Date Published: 2022-01-01
Start Page: 411
End Page: 419
Language: English
DOI: 10.1016/j.jtcvs.2021.11.094
PUBMED: 35346491
PROVIDER: scopus
PMCID: PMC9288545
DOI/URL:
Notes: Conference Paper -- Export Date: 1 August 2022 -- Source: Scopus
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MSK Authors
  1. Meier Hsu
    169 Hsu
  2. Valerie W Rusch
    869 Rusch
  3. Bernard J Park
    265 Park
  4. Matthew Bott
    136 Bott
  5. Manjit S Bains
    338 Bains
  6. David Randolph Jones
    418 Jones
  7. Daniela   Molena
    277 Molena
  8. Kay See   Tan
    244 Tan
  9. James Michael Isbell
    128 Isbell
  10. Smita Sihag
    98 Sihag
  11. Gaetano Rocco
    132 Rocco
  12. Rebecca Ann Carr
    22 Carr