title: Neoadjuvant chemoradiotherapy for esophageal cancer: impact on extracapsular lymph node involvement.
abstract: OBJECTIVE
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of General, Visceral and Cancer Surgery, Center for Integrated Oncology, University Hospital of Cologne, Kerpener Strasse 62, Cologne, Germany. ralf.metzger@uk-koeln.de
authors.forename: Ralf
authors.initials: R
authors.lastname: Metzger
authors.forename: Elfriede
authors.initials: E
authors.lastname: Bollschweiler
authors.forename: Uta
authors.initials: U
authors.lastname: Drebber
authors.forename: Stefan P
authors.initials: SP
authors.lastname: Mönig
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Schröder
authors.forename: Hakan
authors.initials: H
authors.lastname: Alakus
authors.forename: Martin
authors.initials: M
authors.lastname: Kocher
authors.forename: Stephan E
authors.initials: SE
authors.lastname: Baldus
authors.forename: Arnulf H
authors.initials: AH
authors.lastname: Hölscher
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004938:Esophageal Neoplasms / Q000175:diagnosis / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology*; D016629:Esophagectomy / Q000379:methods; D005260:Female; D006801:Humans; D008207:Lymphatic Metastasis; D008297:Male; D008495:Medical Oncology / Q000379:methods; D008875:Middle Aged; D020360:Neoadjuvant Therapy / Q000379:methods*; D009362:Neoplasm Metastasis; D011379:Prognosis; D016896:Treatment Outcome