The Number of Pathologic Lymph Nodes Involved is Still a Significant Prognostic Factor Even After Neoadjuvant Chemoradiotherapy in Esophageal Squamous Cell Carcinoma

Background: The correlation between the number of pathologic metastatic LNs in patients with esophageal squamous cell carcinoma (ESCC) after neoadjuvant chemoradiotherapy (NACRT) and surgical outcome has rarely been reported. We evaluated the correlation between the number of pathologic metastatic lymph nodes (LNs) and the surgical outcome in ESCC after NACRT. Methods: Eighty-eight patients with ESCC who underwent NACRT followed by surgery were evaluated. The clinical response of NACRT was evaluated and surgical specimens of the primary tumor and resected LNs were analyzed clinicopathologically. Results: Fewer pathologic metastatic LNs was associated with better survival. According to the number of metastatic LNs, the difference in the median survival was the largest between the groups when patients were divided into those with 2 and 3 metastatic LNs (chi(2): 13.694, P < 0.001). With regard to clinical factors, the initial N status prior to treatment had the most significant impact on survival by a univariate analysis (P = 0.064), and the number of pathologic metastatic LNs was a risk factor for poor survival, with a hazard ratio of 5.128 (95% C.I.: 1.438-18.285, P = 0.012) by a multivariate analysis. Conclusions: Of the various factors, the number of pathologic metastatic LNs was the strongest indicator to predict the patients' survival. J. Surg. Oncol. 2012; 105:756-760. (C) 2011 Wiley Periodicals, Inc.