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Background: Pathological lymph node metastasis (LNM) following multimodal therapy is an important indicator of poor prognosis in patients with esophageal cancer. However, a significant number of patients without LNM are still at high risk for recurrence.

Methods: We assessed prognostic factors in 143 patients without pathological LNM who were diagnosed with locally advanced esophageal squamous cell carcinoma (ESCC) and underwent neoadjuvant chemotherapy (NAC) or chemoradiotherapy (NACRT), followed by surgery.

Results: Using univariate and multivariate analyses of recurrence-free survival, carcinoembryonic antigen (CEA) levels (hazard ratio [HR]: 2.17, 95% confidence interval [CI]: 1.12-4.23, and p = 0.02) and neutrophil-to-lymphocyte ratio (NLR) (HR: 1.22, 95% CI: 1.04-1.43, and p = 0.02) were significant independent covariates. Furthermore, pretherapeutic LNM (HR: 1.94, 95% CI: 1.003-3.76, and p = 0.049), NACRT (HR: 3.29, 95% CI: 1.30-8.33, and p = 0.01), poorly differentiated tumors (HR: 2.52, 95% CI: 1.28-4.98, and p = 0.01), and lymphovascular invasion (LVI) (HR: 2.78, 95% CI: 1.27-6.09, and p = 0.01) were also significant independent covariates. The recurrence rates among patients with 0/1, 2, 3, and 4/5 poor prognostic factors were significantly different (5.0%, 25.0%, 35.7%, and 53.8%, respectively; p = 0.001); the survival rates were stratified among these prognostic groups.

Conclusions: Pretherapeutic CEA and NLR levels, pretherapeutic LNM, NACRT, poorly differentiated tumors, and LVI were significantly correlated with survivals in patients without pathological LNM after neoadjuvant therapy and surgery. Postoperative therapy should be considered in patients with ESCC with several indicators of recurrence, even in those without pathological LNM who underwent surgery following neoadjuvant therapy.

Titel:	Prognostic factors for esophageal squamous cell carcinoma without pathological lymph node metastasis after neoadjuvant therapy and surgery.
Autor/in / Beteiligte Person:	Hamai, Y ; Emi, M ; Ibuki, Y ; Murakami, Y ; Nishibuchi, I ; Kurokawa, T ; Yoshikawa, T ; Hirohata, R ; Ohsawa, M ; Kitasaki, N ; Okada, M
Zeitschrift:	World journal of surgery, Jg. 48 (2024-02-01), Heft 2, S. 416-426
Veröffentlichung:	2024- : [Hoboken, NJ] : Wiley ; <i>Original Publication</i>: New York, Springer International., 2024
Medientyp:	academicJournal
ISSN:	1432-2323 (electronic)
DOI:	10.1002/wjs.12033
Schlagwort:	Humans Neoadjuvant Therapy Prognosis Lymphatic Metastasis Carcinoembryonic Antigen Neoplasm Staging Retrospective Studies Esophageal Squamous Cell Carcinoma therapy Esophageal Squamous Cell Carcinoma pathology Esophageal Neoplasms surgery Carcinoma, Squamous Cell surgery
Sonstiges:	Nachgewiesen in: MEDLINE Sprachen: English Publication Type: Journal Article Language: English [World J Surg] 2024 Feb; Vol. 48 (2), pp. 416-426. <i>Date of Electronic Publication: </i>2023 Dec 13. MeSH Terms: Esophageal Squamous Cell Carcinoma* / therapy ; Esophageal Squamous Cell Carcinoma* / pathology ; Esophageal Neoplasms* / surgery ; Carcinoma, Squamous Cell* / surgery ; Humans ; Neoadjuvant Therapy ; Prognosis ; Lymphatic Metastasis ; Carcinoembryonic Antigen ; Neoplasm Staging ; Retrospective Studies References: Nakamura, Kenichi, Ken Kato, Hiroyasu Igaki, Yoshinori Ito, Junki Mizusawa, Nobutoshi Ando, Harushi Udagawa, Yasuhiro Tsubosa, Hiroyuki Daiko, Shuichi Hironaka, Haruhiko Fukuda, and Yuko Kitagawa. 2013. “Three-Arm Phase III Trial Comparing Cisplatin Plus 5-FU (CF) Versus Docetaxel, Cisplatin Plus 5-FU (DCF) Versus Radiotherapy with CF (CF-RT) as Preoperative Therapy for Locally Advanced Esophageal Cancer (JCOG1109, NExT Study).” Japanese Journal of Clinical Oncology 43(7): 752-755. https://doi.org/10.1093/jjco/hyt061. ; van Hagen, P., M. C. Hulshof, J. J. van Lanschot, E. W. Steyerberg, M. I. van Berge Henegouwen, B. P. Wijnhoven, D. J. Richel, G. A. 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Contributed Indexing: Keywords: cancer; chemotherapy; esophagus; pathology; radiation; recurrence; surgery; survival Substance Nomenclature: 0 (Carcinoembryonic Antigen) Entry Date(s): Date Created: 20240203 Date Completed: 20240205 Latest Revision: 20240612 Update Code: 20240612

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Prognostic factors for esophageal squamous cell carcinoma without pathological lymph node metastasis after neoadjuvant therapy and surgery.