Association of Pathologic Lymph Node Regression After Neoadjuvant Chemotherapy With Outcomes in Esophageal Adenocarcinoma

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In a UK study reported in the Journal of Clinical Oncology, Moore et al found that increased pathologic lymph node regression after neoadjuvant chemotherapy was associated with better outcomes in esophageal adenocarcinoma.

Study Details

The study involved patients treated with neoadjuvant chemotherapy followed by surgical resection at five high-volume UK centers between January 2000 and August 2020.

Lymph nodes retrieved at surgery were evaluated for chemotherapy response and given a lymph node regression score (LNRS):

  • 1 = complete response
  • 2 = < 10% residual tumor
  • 3 = 10% to 50% residual tumor
  • 4 = > 50% residual tumor
  • 5 = no response.

Key Findings

In total, 17,930 lymph nodes from 763 patients were examined. Lymph node response classifications were: complete lymph node response (LNRS 1 in ≥ 1 lymph node, no residual tumor in any lymph node) in 62 patients (8.1%); partial lymph node response (LNRS 1–3 in ≥ 1 lymph node, residual tumor ≥ 1 lymph node) in 155 patients (20.3%); poor/no lymph node response (LNRS 4–5) in 303 patients (39.7%), or lymph node–negative (no tumor/regression) in 243 patients (31.8%).

Compared with patients with poor/no lymph node response, overall survival was significantly better among those with complete lymph node response (hazard ratio [HR] = 0.35, 95% confidence interval [CI] = 0.22–0.56), partial lymph node response (HR = 0.72, 95% CI = 0.57–0.93), and negative lymph nodes (HR = 0.32, 95% CI = 0.25–0.42).

Rates of tumor recurrence were 66.7% among patients with poor/no lymph node response, 50.3% among those with partial lymph node response, 23.0% among those who were lymph node–negative, and 19.4% among those with complete lymph node response (overall P < .0001).

Primary tumor regression and lymph node regression were discordant in 165 patients (21.9%).

The investigators concluded, “Pathological lymph node regression after neoadjuvant chemotherapy was a strong prognostic factor and provides important information beyond pathological TNM staging and primary tumor regression grading. Lymph node regression should be included as standard in the pathological reporting of esophagectomy specimens.”

Andrew R. Davies, MD, FRCS, of the Department of Upper Gastrointestinal and General Surgery, St Thomas’ Hospital, London, is the corresponding author for the Journal of Clinical Oncology article.  

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