title: Survival in lymph node negative adenocarcinoma of the esophagus after R0 resection with and without neoadjuvant therapy: evidence for downstaging of N status.
abstract: BACKGROUND
  After esophagectomy, many patients who received neoadjuvant therapy have no evidence of lymph node involvement (N0 disease). Whether lymph nodes were initially involved and eradicated by the neoadjuvant therapy (down-staged) or if the nodes were never involved is a subject of debate. To address this issue, we compared clinical outcomes in N0 patients treated with neoadjuvant therapy with outcomes in patients treated with surgery alone.
  
  
  METHODS
  We reviewed records of 100 consecutive patients who underwent R0 esophagectomy for adenocarcinoma with pathologic N0 status. Seventy-five patients were treated by operation alone and 25 received neoadjuvant therapy. Tumor characteristics including length, depth, lymphovascular invasion, and degree of differentiation were compared and longterm survival was assessed by Kaplan-Meier analysis at a median of 46 months (interquartile range 26 to 77 months).
  
  
  RESULTS
  Tumor characteristics were similar between groups. Recurrence was more common in patients who received neoadjuvant therapy compared with those treated with surgery alone (10 of 25 versus 10 of 75, p=0.0063). Patients with N0 disease after neoadjuvant therapy had a significantly worse survival than patients treated by surgery alone (49% versus 85%, p=0.005).
  
  
  CONCLUSIONS
  Although neoadjuvant therapy may eradicate lymph node metastases, it does not result in the same outcomes as those achieved in patients with N0 disease treated with surgery alone. The poor clinical outcomes observed in N0 patients after neoadjuvant therapy suggest that they initially had node involvement and were downstaged by eradication of lymph node disease.
authors.affiliation: Department of Surgery, University of Southern California, Los Angeles, CA, USA.
authors.forename: Jessica M
authors.initials: JM
authors.lastname: Leers
authors.forename: Shahin
authors.initials: S
authors.lastname: Ayazi
authors.forename: Jeffrey A
authors.initials: JA
authors.lastname: Hagen
authors.forename: Sergei
authors.initials: S
authors.lastname: Terterov
authors.forename: Nancy
authors.initials: N
authors.lastname: Klipfel
authors.forename: Arzu
authors.initials: A
authors.lastname: Oezcelik
authors.forename: Emmanuele
authors.initials: E
authors.lastname: Abate
authors.forename: John C
authors.initials: JC
authors.lastname: Lipham
authors.forename: Steven R
authors.initials: SR
authors.lastname: DeMeester
authors.forename: Farzaneh
authors.initials: F
authors.lastname: Banki
authors.forename: Tom R
authors.initials: TR
authors.lastname: DeMeester
mesh_terms: D000230:Adenocarcinoma / Q000401:mortality* / Q000473:pathology / Q000601:surgery*; D000368:Aged; D004938:Esophageal Neoplasms / Q000401:mortality* / Q000473:pathology / Q000601:surgery*; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008197:Lymph Node Excision; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D009361:Neoplasm Invasiveness; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology; D009367:Neoplasm Staging; D011379:Prognosis; D012189:Retrospective Studies