• William B Robb, Laetitia Dahan, Françoise Mornex, Emilie Maillard, Pascal-Alexandre Thomas, Bernard Meunier, Valérie Boige, Denis Pezet, Valérie Le Brun-Ly, Jean-François Bosset, Jean-Yves Mabrut, Jean-Pierre Triboulet, Laurent Bedenne, Jean-François Seitz, Christophe Mariette, and Fédération Française de Cancérologie Digestive, Société Française de Radiothérapie Oncologique, Union des Centres de Lutte Contre le Cancer, Groupe Coopérateur Multidisciplinaire en Oncologie, French EsoGAstric Tumour working group, Fédération de Recherch.
• *SIRIC ONCOLille and Université Lille-Nord de France †Inserm, UMR837, Team 5 "Mucins, epithelial differentiation and carcinogenesis" Jean Pierre Aubert Research Center, Lille, France ‡Department of Surgical Oncology, Lille University Hospital, Lille, France §Department of Digestive Oncology, La Timone Hospital, Aix-Marseille University, Marseille, France ¶Department of Radiotherapy, Pierre-Bénite Hospital, Lyon, France ‖Department of Biostatistics, Fédération Française de Cancérologie Digestive, Dijon, France **Department of Thoracic Surgery, Hôpital Nord, Marseille, France ††Department of Digestive Surgery, University Hospital, Rennes, France ‡‡Department of Oncology, Gustave Roussy, Villejuif, France §§Department of Oncology, University Hospital, Clermont-Ferrand, France ¶¶Department of Gastroenterology, University Hospital, Limoges, France ‖‖Department of Radiotherapy, University Hospital of Besançon, Besançon, France ***Department of Digestive Surgery, Croix-Rousse University Hospital, Lyon, France †††Department of Gastroenterology, University Hospital of Dijon, Dijon, France.
• Ann. Surg.. 2015 May 1;261(5):902-8.

ObjectiveThe study objectives were to analyze the impact of the number of lymph nodes (LNs) reported as resected (NLNr) and the number of LNs invaded (NLNi) on the prognosis of esophageal cancer (EC) after neoadjuvant chemoradiotherapy.BackgroundPathological LN status is a major disease prognostic factor and marker of surgical quality. The impact of neoadjuvant chemoradiation (nCRT) on LN status remains poorly studied in EC.MethodsPost hoc analysis from a phase III randomized controlled trial comparing nCRT and surgery (group nCRT) to surgery alone (group S) in stage I and II EC (NCT00047112). Only patients who underwent surgical resection were considered (n = 170).ResultsnCRT resulted in tumoral downstaging (pT0, 40.7% vs 1.1%, P < 0.001), LN downstaging (pN0, 69.1% vs 47.2%, P = 0.016), and reduction in the median NLNr [16.0 (range, 0-47.0) vs 22.0 (range, 3.0-58.0), P = 0.001] and NLNi [0 (range, 0-25) vs 1.0 (range, 0-25), P = 0.001]. A good histological response (TRG1/2) in the resected esophageal specimen correlated with reduced median NLNi [0 (range, 0-10) vs 1.0 (range, 0-4), P = 0.007]. After adjustment by treatment, NLNi [hazards ratio (HR) (1-3 vs 0) 3.5, 95% confidence interval (CI): 2.3-5.5, and HR (>3 vs 0) 3.5, 95% CI: 2.0-6.2, P < 0.001] correlated with prognosis, whereas NLNr [HR (<15 vs ≥15) 0.95, 95% CI: 0.6-1.4, P = 0.807 and HR (<23 vs ≥23) 1.4, 95% CI: 0.9-2.0, P = 0.131] did not. In Poisson regression analysis, nCRT was an independent predictive variable for reduced NLNr [exp(coefficient) 0.80, 95% CI: 0.66-0.96, P = 0.018].ConclusionsnCRT is not only responsible for disease downstaging but also predicts fewer LNs being identified after surgical resection for EC. This has implications for the current quality criteria for surgical resection.

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