title: Significant understaging is seen in clinically staged T2N0 esophageal cancer patients undergoing esophagectomy.
abstract: This study aimed to determine the impact of preoperative staging on the treatment of clinical T2N0 (cT2N0) esophageal cancer patients undergoing esophagectomy. We reviewed a retrospective cohort of 27 patients treated at a single institution between 1999 and 2011. Clinical staging was performed with computed tomography, positron emission tomography, and endoscopic ultrasound. Patients were separated into two groups: neoadjuvant therapy followed by surgery (NEOSURG) and surgery alone (SURG). There were 11 patients (41%) in the NEOSURG group and 16 patients (59%) in the SURG group. In the NEOSURG group, three of 11 patients (27%) had a pathological complete response and eight (73%) were partial or nonresponders after neoadjuvant therapy. In the SURG group, nine of 16 patients (56%) were understaged, 6 (38%) were overstaged, and 1 (6%) was correctly staged. In the entire cohort, despite being clinically node negative, 14 of 27 patients (52%) had node-positive disease (5/11 [45%] in the NEOSURG group, and 9/16 [56%] in the SURG group). Overall survival rate was not statistically significant between the two groups (P = 0.96). Many cT2N0 patients are clinically understaged and show no preoperative evidence of node-positive disease. Consequently, neoadjuvant therapy may have a beneficial role in treatment.
authors.affiliation: Department of Surgery, Digestive Health Center & the Knight Cancer Institute, Oregon Health and Science University, Portland, Oregon, USA.
authors.forename: J P
authors.initials: JP
authors.lastname: Dolan
authors.affiliation: Department of Surgery, Digestive Health Center & the Knight Cancer Institute, Oregon Health and Science University, Portland, Oregon, USA.
authors.forename: T
authors.initials: T
authors.lastname: Kaur
authors.affiliation: Department of Surgery, Digestive Health Center & the Knight Cancer Institute, Oregon Health and Science University, Portland, Oregon, USA.
authors.forename: B S
authors.initials: BS
authors.lastname: Diggs
authors.affiliation: Department of Surgery, Digestive Health Center & the Knight Cancer Institute, Oregon Health and Science University, Portland, Oregon, USA.
authors.forename: R A
authors.initials: RA
authors.lastname: Luna
authors.affiliation: Department of Surgery, Digestive Health Center & the Knight Cancer Institute, Oregon Health and Science University, Portland, Oregon, USA.
authors.forename: B C
authors.initials: BC
authors.lastname: Sheppard
authors.affiliation: Department of Surgery, Division of Cardiothoracic Surgery & the Knight Cancer Institute, Oregon Health and Science University, Portland, Oregon, USA.
authors.forename: P H
authors.initials: PH
authors.lastname: Schipper
authors.affiliation: Department of Surgery, Division of Cardiothoracic Surgery & the Knight Cancer Institute, Oregon Health and Science University, Portland, Oregon, USA.
authors.forename: B H
authors.initials: BH
authors.lastname: Tieu
authors.affiliation: Department of Medicine, Division of Gastroenterology & the Digestive Health Center, Oregon Health and Science University, Portland, Oregon, USA.
authors.forename: G
authors.initials: G
authors.lastname: Bakis
authors.affiliation: Department of Medicine, Division of Hematology & Medical Oncology, Oregon Health and Science University, Portland, Oregon, USA.
authors.forename: G M
authors.initials: GM
authors.lastname: Vaccaro
authors.affiliation: Department of Radiation Medicine & the Knight Cancer Institute, Oregon Health and Science University, Portland, Oregon, USA.
authors.forename: J M
authors.initials: JM
authors.lastname: Holland
authors.affiliation: Department of Pathology, Oregon Health and Science University, Portland, Oregon, USA.
authors.forename: K M
authors.initials: KM
authors.lastname: Gatter
authors.affiliation: Department of Surgery, Digestive Health Center & the Knight Cancer Institute, Oregon Health and Science University, Portland, Oregon, USA.
authors.forename: M A
authors.initials: MA
authors.lastname: Conroy
authors.affiliation: Department of Radiation Medicine & the Knight Cancer Institute, Oregon Health and Science University, Portland, Oregon, USA.
authors.forename: C A
authors.initials: CA
authors.lastname: Thomas
authors.affiliation: Department of Surgery, Digestive Health Center & the Knight Cancer Institute, Oregon Health and Science University, Portland, Oregon, USA.
authors.forename: J G
authors.initials: JG
authors.lastname: Hunter
mesh_terms: D000230:Adenocarcinoma / Q000401:mortality / Q000473:pathology / Q000601:surgery; D000328:Adult; D000368:Aged; D059186:Chemoradiotherapy, Adjuvant / Q000379:methods; D004938:Esophageal Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery; D016629:Esophagectomy / Q000379:methods / Q000706:statistics & numerical data; D004945:Esophagoscopy / Q000379:methods; D005260:Female; D006801:Humans; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D010043:Outcome and Process Assessment, Health Care; D049268:Positron-Emission Tomography / Q000379:methods; D057234:Preoperative Period; D015996:Survival Rate; D014057:Tomography, X-Ray Computed / Q000379:methods; D014481:United States / Q000453:epidemiology
keywords: chemotherapy; esophageal cancer; esophagectomy; neoadjuvant therapy; oesophageal cancer; radiation therapy