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Background <p>The prognostic role of lymphadenectomy during esophagectomy for esophageal cancer in complete responders to neoadjuvant therapy is uncertain. This study aimed to help clarify this question.</p> Patients and Methods <p>This was a bi-national population-based cohort study in Sweden (2006–2024) and Finland (2006–2019). The main cohort included 515 patients with esophageal cancer who underwent esophagectomy after complete or near-complete tumor response without lymph node metastasis following neoadjuvant therapy. A secondary cohort included 669 patients with similar tumor response, regardless of nodal status. Data came from medical records and national health data registers. Associations between lymphadenectomy (categorized in quartiles) and 5-year mortality were assessed using multivariable Cox regression, yielding hazard ratios (HR) with 95% confidence intervals (CI), adjusted for age, sex, country, comorbidity, type of neoadjuvant therapy, calendar year, tumor histology, hospital volume, tumor location, tumor response, and T stage.</p> Results <p>In the main cohort, comparing the highest quartile of lymphadenectomy (≥ 27 nodes) with the lowest (0–11 nodes) indicated decreased 5-year all-cause mortality (HR 0.54, 95% CI 0.34–0.88). Stratified analyses suggested no significant association for complete responders (HR 0.68, 95% CI 0.39–1.16), but for near-complete responders (HR 0.32, 95% CI 0.14–0.72). The associations disappeared when assessing stage purification bias in the secondary cohort (<i>n</i> = 669), with the corresponding HRs of 0.91 (95% CI 0.63–1.32) for all responders, 1.01 (95% CI 0.61–1.66) for complete responders, and 0.79 (95% CI 0.47–1.33) for near-complete responders. Results were similar for 5-year disease-specific mortality.</p> Conclusions <p>After considering stage purification bias, more extensive lymphadenectomy did not improve the long-term survival among patients with complete or near-complete tumor response after neoadjuvant therapy.</p>

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The Prognostic Role of Lymphadenectomy during Esophagectomy for Esophageal Cancer with Complete or Near-Complete Tumor Response after Neoadjuvant Therapy

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2025年11月6日

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  • Wilhelm Leijonmarck,
  • Fredrik Mattsson,
  • Eivind Gottlieb-Vedi,
  • Ellinor Wiström,
  • Joonas H. Kauppila,
  • Olli Helminen,
  • Mika Helmio,
  • Heikki Huhta,
  • Anna Junttila,
  • Vesa Koivukangas,
  • Arto Kokkola,
  • Elina Lietzen,
  • Johanna Louhimo,
  • Sanna Merilainen,
  • Vesa-Matti Pohjanen,
  • Tuomo Rantanen,
  • Ari Ristimaki,
  • Jari V Rasanen,
  • Eero Sihvo,
  • Tuula Tyrvainen,
  • Antti Valtola,
  • Joonas H. Kauppila,
  • Jesper Lagergren

摘要

Background

The prognostic role of lymphadenectomy during esophagectomy for esophageal cancer in complete responders to neoadjuvant therapy is uncertain. This study aimed to help clarify this question.

Patients and Methods

This was a bi-national population-based cohort study in Sweden (2006–2024) and Finland (2006–2019). The main cohort included 515 patients with esophageal cancer who underwent esophagectomy after complete or near-complete tumor response without lymph node metastasis following neoadjuvant therapy. A secondary cohort included 669 patients with similar tumor response, regardless of nodal status. Data came from medical records and national health data registers. Associations between lymphadenectomy (categorized in quartiles) and 5-year mortality were assessed using multivariable Cox regression, yielding hazard ratios (HR) with 95% confidence intervals (CI), adjusted for age, sex, country, comorbidity, type of neoadjuvant therapy, calendar year, tumor histology, hospital volume, tumor location, tumor response, and T stage.

Results

In the main cohort, comparing the highest quartile of lymphadenectomy (≥ 27 nodes) with the lowest (0–11 nodes) indicated decreased 5-year all-cause mortality (HR 0.54, 95% CI 0.34–0.88). Stratified analyses suggested no significant association for complete responders (HR 0.68, 95% CI 0.39–1.16), but for near-complete responders (HR 0.32, 95% CI 0.14–0.72). The associations disappeared when assessing stage purification bias in the secondary cohort (n = 669), with the corresponding HRs of 0.91 (95% CI 0.63–1.32) for all responders, 1.01 (95% CI 0.61–1.66) for complete responders, and 0.79 (95% CI 0.47–1.33) for near-complete responders. Results were similar for 5-year disease-specific mortality.

Conclusions

After considering stage purification bias, more extensive lymphadenectomy did not improve the long-term survival among patients with complete or near-complete tumor response after neoadjuvant therapy.