Journal article
Survival in Lymph Node Negative Adenocarcinoma of the Esophagus after R0 Resection With and Without Neoadjuvant Therapy: Evidence for Downstaging of N Status
Journal of the American College of Surgeons, v 208(4), pp 553-556
01 Apr 2009
PMID: 19476789
Featured in Collection : UN Sustainable Development Goals @ Drexel
Abstract
BACKGROUND: After esophagectomy, many patients who received neoadjuvant therapy have no evidence of lymph node involvement (N0 disease). Whether lymph nodes were initially involved and eradicated by the neoadjuvant therapy (down-staged) or if the nodes were never involved is a subject of debate. To address this issue, we compared clinical outcomes in N0 patients treated with neoadjuvant therapy with outcomes in patients treated with surgery alone.
STUDY DESIGN: We reviewed records of 100 consecutive patients who underwent R0 esophagectomy for adenocarcinoma with pathologic N0 status. Seventy-five patients were treated by operation alone and 25 received neoadjuvant therapy. Tumor characteristics including length, depth, lymphovascular invasion, and degree of differentiation were compared and longterm survival was assessed by Kaplan-Meier analysis at a median of 46 months (interquartile range 26 to 77 months).
RESULTS: Tumor characteristics were similar between groups. Recurrence was more common in patients who received neoadjuvant therapy compared with those treated with surgery alone (10 of 25 versus 10 of 75, p = 0.0063). Patients with N0 disease after neoadjuvant therapy had a significantly worse survival than patients treated by surgery alone (49% versus 85%, p = 0.005).
CONCLUSIONS: Although neoadjuvant therapy may eradicate lymph node metastases, it does not result in the same outcomes as those achieved in patients with N0 disease treated with surgery alone. The poor clinical outcomes observed in N0 patients after neoadjuvant therapy suggest that they initially had node involvement and were downstaged by eradication of lymph node disease. (J Am Coll Surg 2009;208:553-556. (C) 2009 by the American College of Surgeons)
Metrics
Details
- Title
- Survival in Lymph Node Negative Adenocarcinoma of the Esophagus after R0 Resection With and Without Neoadjuvant Therapy: Evidence for Downstaging of N Status
- Creators
- Jessica M. Leers - University of Southern CaliforniaShahin Ayazi - University of Southern CaliforniaJeffrey A. Hagen - University of Southern CaliforniaSergei Terterov - University of Southern CaliforniaNancy Klipfel - University of Southern CaliforniaArzu Oezcelik - University of Southern CaliforniaEmmanuele Abate - University of Southern CaliforniaJohn C. Lipham - University of Southern CaliforniaSteven R. DeMeester - University of Southern CaliforniaFarzaneh Banki - University of Southern CaliforniaTom R. DeMeester - University of Southern California
- Publication Details
- Journal of the American College of Surgeons, v 208(4), pp 553-556
- Publisher
- Elsevier
- Number of pages
- 4
- Resource Type
- Journal article
- Language
- English
- Academic Unit
- Surgery
- Web of Science ID
- WOS:000270996800009
- Scopus ID
- 2-s2.0-62349141015
- Other Identifier
- 991022048293404721
UN Sustainable Development Goals (SDGs)
This publication has contributed to the advancement of the following goals:
InCites Highlights
Data related to this publication, from InCites Benchmarking & Analytics tool:
- Web of Science research areas
- Surgery