title: Prognostic impact of extracapsular lymph node involvement after neoadjuvant therapy and oesophagectomy.
abstract: BACKGROUND
  The significance of extracapsular lymph node involvement (LNI) is unclear in patients with oesophageal cancer who have undergone neoadjuvant treatment followed by oesophagectomy. The aim of this study was to assess the incidence and prognostic significance of extracapsular LNI in a large multicentre series of consecutive patients with oesophageal cancer treated by neoadjuvant chemotherapy or chemoradiotherapy and surgery.
  
  
  METHODS
  Data from a consecutive series of patients treated at two European centres were analysed. All patients with squamous cell carcinoma or adenocarcinoma of the oesophagus or gastro-oesophageal junction, who received neoadjuvant chemotherapy or chemoradiation followed by transthoracic oesophagectomy and two-field lymphadenectomy with curative intent, were included.
  
  
  RESULTS
  Between January 2000 and September 2013, 704 patients underwent oesophagectomy after neoadjuvant therapy. A median of 28 (range 5-77) nodes per patient was recovered. Some 347 patients (49·3 per cent) had no LNI (ypN0). Of the remaining 357 patients (50·7 per cent) with LNI (ypN1-3), extracapsular LNI was found in 190 (53·2 per cent). Five-year overall survival rates were 62·7 per cent for patients with N0 disease, 44·9 per cent for patients without extracapsular spread and 14·0 per cent where extracapsular LNI was identified (P < 0·001). Multivariable analyses demonstrated the presence of extracapsular LNI as an independent prognostic factor.
  
  
  CONCLUSIONS
  The presence of extracapsular LNI after neoadjuvant therapy carries a poor prognosis.
authors.affiliation: Departments of Surgery, Academic Medical Centre, Amsterdam, The Netherlands.
authors.forename: S M
authors.initials: SM
authors.lastname: Lagarde
authors.affiliation: Northern Oesophago-Gastric Cancer Unit, Royal Victoria Infirmary, Newcastle upon Tyne, UK. navidi@doctors.org.uk.
authors.forename: M
authors.initials: M
authors.lastname: Navidi
authors.affiliation: Departments of Surgery, Academic Medical Centre, Amsterdam, The Netherlands.
authors.forename: S S
authors.initials: SS
authors.lastname: Gisbertz
authors.affiliation: Departments of Medical Oncology, Academic Medical Centre, Amsterdam, The Netherlands.
authors.forename: H W M
authors.initials: HW
authors.lastname: van Laarhoven
authors.affiliation: Departments of Oncology, Royal Victoria Infirmary, Newcastle upon Tyne, UK.
authors.forename: K
authors.initials: K
authors.lastname: Sumpter
authors.affiliation: Departments of Pathology, Academic Medical Centre, Amsterdam, The Netherlands.
authors.forename: S L
authors.initials: SL
authors.lastname: Meijer
authors.affiliation: Departments of Pathology, Royal Victoria Infirmary, Newcastle upon Tyne, UK.
authors.forename: B
authors.initials: B
authors.lastname: Disep
authors.affiliation: Northern Oesophago-Gastric Cancer Unit, Royal Victoria Infirmary, Newcastle upon Tyne, UK.
authors.forename: A
authors.initials: A
authors.lastname: Immanuel
authors.affiliation: Northern Oesophago-Gastric Cancer Unit, Royal Victoria Infirmary, Newcastle upon Tyne, UK.
authors.forename: S M
authors.initials: SM
authors.lastname: Griffin
authors.affiliation: Departments of Surgery, Academic Medical Centre, Amsterdam, The Netherlands.
authors.forename: M I
authors.initials: MI
authors.lastname: van Berge Henegouwen
mesh_terms: D000230:Adenocarcinoma / Q000188:drug therapy / Q000401:mortality / Q000601:surgery*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D002294:Carcinoma, Squamous Cell / Q000188:drug therapy / Q000401:mortality / Q000601:surgery*; D017024:Chemotherapy, Adjuvant / Q000401:mortality; D004938:Esophageal Neoplasms / Q000188:drug therapy / Q000401:mortality / Q000601:surgery*; D016629:Esophagectomy / Q000379:methods* / Q000401:mortality; D004943:Esophagogastric Junction / Q000601:surgery; D005260:Female; D006801:Humans; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy / Q000401:mortality; D011379:Prognosis; D018714:Radiotherapy, Adjuvant / Q000401:mortality; D055815:Young Adult