Neoadjuvant therapy reduces the incidence of nodal micrometastases in esophageal adenocarcinoma

Abstract

Background: We evaluated the impact of neoadjuvant chemoradiotherapy (CRT) on nodal micrometastases (NMMs) in esophageal adenocarcinoma (EAC) patients with histologically negative nodes ([y]pN0).

Methods: Of 48 consecutively treated patients with neoadjuvant CRT, we selected 20 EAC ypN0 patients (group 1). These patients were matched with 20 pN0 EAC patients who had surgery alone (group 2). Harvested (y)pN0 lymph nodes were examined immunohistochemically (anti-CK8/18 [CAM 5.2]) according to a validated sentinel node protocol. A 3rd group (n = 11) staged as ypN1 after neoadjuvant CRT was used as the control group.

Results: Upstaging to NMM+ occurred in 2 patients (10%) in group 1 and in 8 patients (40%) in group 2 (P = .028). Disease-free and overall survival rates in NMM+ patients in group 1 were worse compared with NMM- patients (P = .014 and P = .003, respectively) but comparable with ypN1 patients (n = 11).

Conclusions: A 30% reduction of NMM+ was obtained after neoadjuvant treatment in (y)pN0 patients. NMM+ after CRT had a negative impact on survival in ypN1 patients. These data warrant further investigation in larger prospective datasets.

Keywords: Esophageal cancer; Neoadjuvant treatment; Nodal micrometastases.