For esophageal cancer, it is not clear if Tumor Node Metastases staging after chemoradiation and resection has the same prognostic significance as patients who undergo resection only.
Dr Simon Law and colleagues from Hong Kong prospectively collected data from 279 patients with intrathoracic squamous cell cancers.
Patients were given chemoradiation from 1995 to 2004.
|With chemoradiation, Tumor stage 4 was found in 5 patients|
|Journal of Gastrointestinal Surgery|
The chemoradiation was given as part of a randomized trial comparing neoadjuvant chemoradiation with surgical resection alone.
Some patients received chemoradiation because of advanced disease at presentation.
The researchers reported that 170 patients had surgical resection only, and 109 had neoadjuvant chemoradiation.
In the surgery group, Tumor 1, 2, 3, and 4 disease was found in 15, 17, 104, and 34 patients, respectively.
The team found that the surgery patients' respective Node 1 rates were 13%, 29%, 58%, and 65%.
With chemoradiation plus surgery, Tumor stages 0, 1, 2, 3, and 4 were found in 48, 12, 23, 21, and 5 patients, respectively.
The researchers noted that the chemoradiation patients respective Node rates were 31%, 17%, 22%, 52%, and 20%.
Logistic regression analysis of factors predictive of nodes showed that Tumor stage correlated with Node 1 status in the surgery group.
However, the researchers found that tumor stage did not correlate with Node 1 status in the chemoradiation plus surgery group.
Dr Law's team concludes, “Cox regression analysis demonstrated that in the surgery group, tumor, node, and R category, and overall Tumor Node Metastases stages, were independent prognostic factors.”
“However, Node, R category, and gender were identified as relevant for chemoradiation plus surgery.”
“After chemoradiation, tumor and overall Tumor Node Metastases stage groupings were not as clearly prognostic as in patients without prior therapy.”
“Nodal status remains an important prognostic factor.”