title: The prognostic value of residual nodal disease following neoadjuvant chemoradiation for esophageal cancer in patients with complete primary tumor response.
abstract: BACKGROUND
  The prognostic significance of residual nodal disease in otherwise complete pathologic responders (ypT0N+) to neoadjuvant chemoradiation (nCRT) for esophageal cancer is unknown.
  
  
  METHODS
  ypT0N+ responders were identified from a single institution database of esophageal cancer patients undergoing esophagectomy and were compared to patients without locoregional disease (ypT0N0) and to non-complete responders (ypT+).
  
  
  RESULTS
  Out of 487 patients, 196 ypT0N0 and 14 ypT0N+ patients were identified. Pre-treatment stage was similar between ypT0N0 and ypT0N+ patients: 66% versus 73% of patients had uT3 disease (P = 0.50) and 76% versus 55% had nodal involvement (P = 0.49), respectively. Locoregional recurrence (43%) was more common in ypT0N+ patients. Median overall survival (OS) was worse in ypT0N+ patients (14.8 months) compared to ypT0N0 patients (92.2 months) and ypT+ patients (38.0 months, P < 0.001). Median OS of ypT0N+ patients was similar to ypT+ stage II (29.6 months, P = 0.84) and stage III (27.5 months, P = 0.95) disease. No difference in median OS existed in patients with residual nodal disease (n = 163) based on local response (14.8 months in ypT0N+ and 22.5 months in ypT+N+ patients, P = 0.55).
  
  
  CONCLUSIONS
  Residual nodal disease in esophageal cancer patients with complete response in the primary tumor following nCRT portends a poor prognosis and behaves similar to pathologic stage II/III disease.
authors.affiliation: Department of Gastrointestinal Oncology, Moffitt Cancer Center and Research Institute, Tampa, Florida.
authors.forename: Aaron U
authors.initials: AU
authors.lastname: Blackham
authors.affiliation: Department of Biostatistics, Moffitt Cancer Center and Research Institute, Tampa, Florida.
authors.forename: Binglin
authors.initials: B
authors.lastname: Yue
authors.affiliation: Department of Gastrointestinal Oncology, Moffitt Cancer Center and Research Institute, Tampa, Florida.
authors.forename: Khaldoun
authors.initials: K
authors.lastname: Almhanna
authors.affiliation: Department of Gastrointestinal Oncology, Moffitt Cancer Center and Research Institute, Tampa, Florida.
authors.forename: Nadia
authors.initials: N
authors.lastname: Saeed
authors.affiliation: Department of Gastrointestinal Oncology, Moffitt Cancer Center and Research Institute, Tampa, Florida.
authors.forename: Jacques P
authors.initials: JP
authors.lastname: Fontaine
authors.affiliation: Department of Radiation Oncology, Moffitt Cancer Center and Research Institute, Tampa, Florida.
authors.forename: Sarah
authors.initials: S
authors.lastname: Hoffe
authors.affiliation: Department of Radiation Oncology, Moffitt Cancer Center and Research Institute, Tampa, Florida.
authors.forename: Ravi
authors.initials: R
authors.lastname: Shridhar
authors.affiliation: Department of Radiation Oncology, Moffitt Cancer Center and Research Institute, Tampa, Florida.
authors.forename: Jessica
authors.initials: J
authors.lastname: Frakes
authors.affiliation: Department of Anatomic Pathology, Moffitt Cancer Center and Research Institute, Tampa, Florida.|Department of Tumor Biology, Moffitt Cancer Center and Research Institute, Tampa, Florida.|Program of Chemical Biology & Molecular Medicine, Moffitt Cancer Center and Research Institute, Tampa, Florida.
authors.forename: Domenico
authors.initials: D
authors.lastname: Coppola
authors.affiliation: Department of Gastrointestinal Oncology, Moffitt Cancer Center and Research Institute, Tampa, Florida.
authors.forename: Jose M
authors.initials: JM
authors.lastname: Pimiento
mesh_terms: D000230:Adenocarcinoma / Q000401:mortality / Q000473:pathology* / Q000628:therapy; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D002294:Carcinoma, Squamous Cell / Q000401:mortality / Q000473:pathology* / Q000628:therapy; D059248:Chemoradiotherapy / Q000401:mortality*; D017024:Chemotherapy, Adjuvant; D004938:Esophageal Neoplasms / Q000401:mortality / Q000473:pathology* / Q000628:therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008198:Lymph Nodes / Q000473:pathology; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy / Q000401:mortality*; D009364:Neoplasm Recurrence, Local / Q000401:mortality / Q000473:pathology* / Q000628:therapy; D009367:Neoplasm Staging; D018365:Neoplasm, Residual / Q000473:pathology*; D011379:Prognosis; D011446:Prospective Studies; D018714:Radiotherapy, Adjuvant; D012074:Remission Induction; D012189:Retrospective Studies; D015996:Survival Rate
keywords: complete pathologic response; esophageal cancer; neoadjuvant chemotherapy; staging systems; treatment guidelines, lymph node metastasis