Pathological Lymph Node Regression After Neoadjuvant Chemotherapy Predicts Recurrence and Survival in Esophageal Adenocarcinoma: A Multicenter Study in the United Kingdom
Menée à partir de l'analyse de 17 930 ganglions lymphatiques provenant de 763 patients atteints d'un adénocarcinome de l'oesophage traité par chimiothérapie adjuvante puis résection chirurgicale, cette étude multicentrique évalue l'association entre la régression de l'atteinte des ganglions lymphatiques après le traitement néoadjuvant et le risque de récidive ou la survie
PURPOSE : There is limited evidence regarding the prognostic effects of pathological lymph node (LN) regression after neoadjuvant chemotherapy for esophageal adenocarcinoma, and a definition of LN response is lacking. This study aimed to evaluate how LN regression influences survival after surgery for esophageal adenocarcinoma.
METHODS : Multicenter cohort study of patients with esophageal adenocarcinoma treated with neoadjuvant chemotherapy followed by surgical resection at five high-volume centers in the United Kingdom. LNs retrieved at esophagectomy were examined for chemotherapy response and given a LN regression score (LNRS)—LNRS 1, complete response; 2, <10% residual tumor; 3, 10%-50% residual tumor; 4, >50% residual tumor; and 5, no response. Survival analysis was performed using Cox regression adjusting for confounders including primary tumor regression. The discriminatory ability of different LN response classifications to predict survival was evaluated using Akaike information criterion and Harrell C-index.
RESULTS : In total, 17,930 LNs from 763 patients were examined. LN response classified as complete LN response (LNRS 1
≥
1 LN, no residual tumor in any LN; n = 62, 8.1%), partial LN response (LNRS 1-3
≥
1 LN, residual tumor
≥
1 LN; n = 155, 20.3%), poor/no LN response (LNRS 4-5; n = 303, 39.7%), or LN negative (no tumor/regression; n = 243, 31.8%) demonstrated superior discriminatory ability. Mortality was reduced in patients with complete LN response (hazard ratio [HR], 0.35; 95% CI, 0.22 to 0.56), partial LN response (HR, 0.72; 95% CI, 0.57 to 0.93) or negative LNs (HR, 0.32; 95% CI, 0.25 to 0.42) compared with those with poor/no LN response. Primary tumor regression and LN regression were discordant in 165 patients (21.9%).
CONCLUSION : Pathological LN regression after neoadjuvant chemotherapy was a strong prognostic factor and provides important information beyond pathological TNM staging and primary tumor regression grading. LN regression should be included as standard in the pathological reporting of esophagectomy specimens.
Journal of Clinical Oncology , résumé, 2022