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Can Lymph Node Response to Neoadjuvant Chemotherapy Predict Prognosis in Esophageal Cancer?

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Key Points

  • CT scans conducted before and after neoadjuvant chemotherapy demonstrated a high discordance in the response between primary tumors and metastatic lymph nodes in patients with esophageal cancer.
  • Every lymph node showed a different response—even those in the same patient.

In a study published by Urakawa et al in Annals of Surgery, researchers found that the response of lymph nodes to neoadjuvant chemotherapy is more effective in predicting disease recurrence and patient survival in individuals with esophageal cancer than the response of primary tumors.

Although imaging techniques such as computed tomography (CT) and endoscopy are often used to examine primary tumors in patients, these techniques are not helpful when trying to measure primary tumors in the esophagus because of its shape. Thus, it is difficult for physicians to estimate recurrence and survival in patients with esophageal cancer. The research team attempted to address this issue by finding another indicator of patient outcome.

“The frequency of lymph node metastases [is] very high, particularly in advanced esophageal cancer compared with other gastrointestinal cancers,” said lead study authors Shinya Urakawa, MD, and Tomoki Makino, MD, PhD. “Consequently, we reasoned that the response of lymph nodes might be more useful than that of primary tumors for predicting chemotherapeutic efficacy and patient prognosis. Accordingly, we aimed to determine the clinical utility of lymph node responses to neoadjuvant chemotherapy for predicting long-term survival in patients with metastatic esophageal cancer.”

Methods and Results

To do this, the researchers used CT to measure metastatic lymph nodes before and after neoadjuvant chemotherapy in individuals with metastatic esophageal cancer. They evaluated the chemotherapeutic response by monitoring the respective sizes of primary tumors and all metastatic lymph nodes that met a specific set of criteria.

“CT scans conducted before and after neoadjuvant chemotherapy demonstrated a high discordance in the response between primary tumors and metastatic lymph nodes in patients with esophageal cancer,” explained researchers.

In fact, the researchers found that every lymph node showed a different response—even those in the same patient. Thus, it might be helpful to consider all metastatic lymph nodes to obtain a precise assessment of the neoadjuvant chemotherapy response.

“The lymph node response facilitated precise predictions of patient prognosis,” said Drs. Urakawa and Makino. In addition to facilitating outcome predictions, this finding could contribute to the optimization of treatment strategies, and eventually lead to improved survival in patients with metastatic esophageal cancer.

The researchers concluded, “The lymph node response to neoadjuvant chemotherapy predicted long-term survival more precisely than the primary tumors response in patients with metastatic esophageal cancer.”

Disclosure: For full disclosures of the study authors, visit insights.ovid.com.

The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.


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