title: Lymph node invasion might have more prognostic impact than R status in advanced esophageal adenocarcinoma.
abstract: BACKGROUND
  Advanced esophageal adenocarcinomas are associated with 5-year survival rates ranging from 14% to 35%. Nodal status and tumor clearance are the main prognostic factors. However, their respective prognostic values have not been compared to date.
  
  
  METHODS
  Seventy consecutive patients with stage T3 adenocarcinomas of the esophagus or gastric cardia were retrospectively assessed. Neoadjuvant therapy was indicated in all cases. Prognostic values of R0 resection and nodal status were evaluated using univariate and multivariate analyses.
  
  
  RESULTS
  Neoadjuvant therapy was achieved in 62 patients, 41 with radiochemotherapy and 21 with perioperative chemotherapy. Transthoracic esophagectomy and transhiatal esophagectomy were performed in 54 and 15 patients, respectively. Clavien-Dindo grade III or IV complications occurred in 16 patients (23%). Two patients died in the hospital (3%). In univariate and multivariate analyses, nodal status was the main independent factor predicting overall survival; tumor clearance (R0 or R1) had less prognostic impact and was not statistically significant. Furthermore, R1 resection was a prognostic indicator for metastatic recurrence.
  
  
  CONCLUSIONS
  These results indicate that nodal status has more prognostic impact than R status in stage T3 adenocarcinomas of the esophagus or gastric cardia. Thus, local control in R1 patients by postoperative radiotherapy is not justified.
authors: Department of Digestive Surgery, University Hospital of Bordeaux, Pessac, France.
authors: Magali
authors: M
authors: Cabau
authors: Guillaume
authors: G
authors: Luc
authors: Eric
authors: E
authors: Terrebonne
authors: Geneviève
authors: G
authors: Belleanne
authors: Véronique
authors: V
authors: Vendrely
authors: Antonio
authors: A
authors: Sa Cunha
authors: Denis
authors: D
authors: Collet
mesh_terms: D000230:Adenocarcinoma / Q000401:mortality* / Q000473:pathology* / Q000628:therapy; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D002299:Cardia / Q000473:pathology; D059248:Chemoradiotherapy; 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; D008197:Lymph Node Excision; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D020360:Neoadjuvant Therapy; D011183:Postoperative Complications; D011379:Prognosis; D012189:Retrospective Studies; D013274:Stomach Neoplasms / Q000401:mortality / Q000473:pathology / Q000628:therapy
chemical_list: D002945:Cisplatin; D005472:Fluorouracil