title: Pre- and post-therapy nodal status equally affects survival of patients with oesophageal squamous cell carcinoma receiving preoperative chemoradiation.
abstract: Patients with deeply invading (T3-T4) oesophageal cancers usually receive chemoradiotherapy with or without surgery. However, the prognostic significance of pre-therapy and post-therapy lymph node (LN) status remains unclear. We studied 195 patients who received chemoradiotherapy for deeply invading oesophageal cancers (T3-4, N0-1, M0). Of these, 105 patients underwent surgery while 90 were treated by chemoradiotherapy alone. Of the 105 surgically treated patients, overall survival was significantly better in cN0 patients than in cN1 (3-year survival rate, 65.3 vs. 25.8%, P=0.0014). This difference was similarly observed in 90 patients who received chemoradiotherapy alone. Patient survival differed significantly among patients with no positive LN, 1 positive LN and 2-4 positive LN (3-year survival rate, 57.1 vs. 40.5 vs. 17.6%, P<0.0001). However, there was no significant difference in survival between patients with 2-4 positive LN and > or =5 positive LN. Multivariate analysis identified pre-therapy LN status and the number of involved LNs as the most important independent prognostic factors prior to histopathological tumour regression. In conclusion, pre-therapy LN status and the number of post-therapy involved LNs equally affect survival of patients who receive neo-adjuvant chemoradiotherapy. Control of systemic metastasis is required, based on pre- and post-therapy LN status.
authors.affiliation: Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Osaka 565-0871, Japan. hmiyata@gesurg.med.osaka-u.ac.jp
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Miyata
authors.forename: Makoto
authors.initials: M
authors.lastname: Yamasaki
authors.forename: Shuji
authors.initials: S
authors.lastname: Takiguchi
authors.forename: Kiyokazu
authors.initials: K
authors.lastname: Nakajima
authors.forename: Yoshiyuki
authors.initials: Y
authors.lastname: Fujiwara
authors.forename: Masaki
authors.initials: M
authors.lastname: Mori
authors.forename: Yuichiro
authors.initials: Y
authors.lastname: Doki
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D002294:Carcinoma, Squamous Cell / Q000401:mortality / Q000556:secondary / Q000628:therapy*; D017024:Chemotherapy, Adjuvant; D002945:Cisplatin / Q000008:administration & dosage; D004938:Esophageal Neoplasms / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D016629:Esophagectomy; D005260:Female; D005472:Fluorouracil / Q000008:administration & dosage; D006801:Humans; D053208:Kaplan-Meier Estimate; D008197:Lymph Node Excision; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D009361:Neoplasm Invasiveness; D009367:Neoplasm Staging; D016016:Proportional Hazards Models; D018714:Radiotherapy, Adjuvant; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D002945:Cisplatin; D005472:Fluorouracil