The Impact of Pretreatment PET/CT Nodal Status on Esophageal Squamous Cell Carcinoma After Neoadjuvant Chemoradiation

• Published in: World journal of surgery Vol. 44; no. 7; pp. 2323 - 2331
• Main Authors: Chen, Jian-Xun, Lu, Ting-Yu, Fang, Hsin-Yuan, Lin, Yu-Sen, Lee, Jang-Ming
• Format: Journal Article
• Language: English
• Published: Cham Springer International Publishing 01.07.2020; John Wiley & Sons, Inc
• Subjects: Abdominal Surgery; Adult; Aged; Cancer; Cardiac Surgery; Chemoradiotherapy; Chemoradiotherapy, Adjuvant; Esophageal cancer; Esophageal Neoplasms - diagnostic imaging; Esophageal Neoplasms - mortality; Esophageal Neoplasms - pathology; Esophageal Neoplasms - therapy; Esophageal Squamous Cell Carcinoma - diagnostic imaging; Esophageal Squamous Cell Carcinoma - mortality; Esophageal Squamous Cell Carcinoma - pathology; Esophageal Squamous Cell Carcinoma - therapy; Esophagectomy; Esophagus; Female; Follow-Up Studies; General Surgery; Humans; Lymph nodes; Lymph Nodes - diagnostic imaging; Lymph Nodes - pathology; Lymphatic Metastasis; Male; Medical prognosis; Medicine; Medicine & Public Health; Middle Aged; Neoadjuvant Therapy; Neoplasm Recurrence, Local - epidemiology; Neoplasm Recurrence, Local - pathology; Neoplasm Staging; Original Scientific Report; Patients; Positron Emission Tomography Computed Tomography; Prognosis; Retrospective Studies; Squamous cell carcinoma; Surgery; Survival; Survival Analysis; Thoracic Surgery; Vascular Surgery
• ISSN: 0364-2313; 1432-2323; 1432-2323
• DOI: 10.1007/s00268-020-05481-7

Background For advanced esophageal cancer, the clinical significance of pretreatment nodal status (cN) as determined by different examinations remains unclear. Patients and methods Patients with esophageal squamous cell carcinoma who underwent neoadjuvant chemoradiation and surgery were analyzed in this study. Pretreatment cN status assessed by CT, EUS, and PET/CT and clinicopathological features were used to evaluate tumor recurrence and long-term survival. Results Two hundred and twenty-two patients were identified in this study. Pretreatment PET/CT cN0 [odds ratio (OR) cN0 versus cN+, 5.316, p  < 0.001] and pretreatment CT cN0 (OR 1.957, p  = 0.032) both independently predicted ypN0. Pretreatment PET/CT cN0 was also associated with a lower recurrence rate and longer survival across the entire study group. Among patients with ypN0, pretreatment PET/CT cN+ indicated poor disease-free survival [hazard ratio (HR) 2.777, p  = 0.001] and overall survival (HR 2.211, p  = 0.034) compared with pretreatment PET/CT cN0, which predicted a favorable prognosis. Conclusions Data from the current study suggest that pretreatment lymph node status as assessed by PET/CT is strongly correlated with survival outcomes after neoadjuvant chemoradiation and surgery in patients with esophageal squamous cell carcinoma. ypN0 patients can achieve better survival outcomes when pretreatment cN0 is assessed by PET/CT.