Nodal Downstaging of Esophageal Cancer After Neoadjuvant Therapy: A Cohort Study and Meta‐Analysis
ABSTRACT Background In esophageal cancer, the ypN0 status after induction therapy could be categorized into two primary groups: “natural N0” (cN0/ypN0) and “down‐staged N0” (cN+/ypN0). The assessment of cN status is typically based on clinical imagination or pathological regression. However, there i...
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| Format: | Article |
| Language: | English |
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Wiley
2025-02-01
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| Series: | Cancer Medicine |
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| Online Access: | https://doi.org/10.1002/cam4.70664 |
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| author | Feng Su Xu Huang Jun Yin Hang Tang Lijie Tan Yaxing Shen |
| author_facet | Feng Su Xu Huang Jun Yin Hang Tang Lijie Tan Yaxing Shen |
| author_sort | Feng Su |
| collection | DOAJ |
| description | ABSTRACT Background In esophageal cancer, the ypN0 status after induction therapy could be categorized into two primary groups: “natural N0” (cN0/ypN0) and “down‐staged N0” (cN+/ypN0). The assessment of cN status is typically based on clinical imagination or pathological regression. However, there is no standardized method for evaluating cN/ypN status. This study aims to investigate the prognosis of patients with cN+/ypN0 using both assessment methods through a cohort study and meta‐analysis. Methods A prospectively maintained database encompassing esophageal cancer patients undergoing induction therapy followed by radical esophagectomy was comprehensively reviewed. The prognostic significance of cN+/ypN0 across two evaluation methods was quantified. Additionally, a meta‐analysis using data from previous studies was conducted. Results 578 patients were identified from the cohort analysis, with 342 classified as ypN0 and 236 as ypN+. When evaluated with clinical imagination, patients with cN+/ypN0 had survival outcomes comparable to those with natural N0 but significantly better than those with ypN+ (p < 0.001). Using pathological nodal regression, cN+/ypN0 patients showed superior overall survival compared to ypN+ patients (p = 0.0043), although their disease‐free survival was notably inferior to that of natural N0 patients (p = 0.0088). A meta‐analysis of 20 previous studies confirmed the prognostic value of cN+/ypN0 status in both clinical imagination and pathological regression. Conclusions For esophageal cancer patients receiving neoadjuvant, cN+/ypN0 status, assessed through both clinical imagination and pathological regression, serves as a significant prognostic factor. It holds precedence over ypN+ yet falls short of the natural N0. The pre‐treatment categorizations warrant recognition as a novel and pertinent staging metric. |
| format | Article |
| id | doaj-art-851e70cd1cb94997963b9da5bba2d346 |
| institution | Kabale University |
| issn | 2045-7634 |
| language | English |
| publishDate | 2025-02-01 |
| publisher | Wiley |
| record_format | Article |
| series | Cancer Medicine |
| spelling | doaj-art-851e70cd1cb94997963b9da5bba2d3462025-08-20T03:27:10ZengWileyCancer Medicine2045-76342025-02-01143n/an/a10.1002/cam4.70664Nodal Downstaging of Esophageal Cancer After Neoadjuvant Therapy: A Cohort Study and Meta‐AnalysisFeng Su0Xu Huang1Jun Yin2Hang Tang3Lijie Tan4Yaxing Shen5Department of Thoracic Surgery, Zhongshan Hospital Fudan University Shanghai ChinaDepartment of Thoracic Surgery, Zhongshan Hospital Fudan University Shanghai ChinaDepartment of Thoracic Surgery, Zhongshan Hospital Fudan University Shanghai ChinaDepartment of Thoracic Surgery, Zhongshan Hospital Fudan University Shanghai ChinaDepartment of Thoracic Surgery, Zhongshan Hospital Fudan University Shanghai ChinaDepartment of Thoracic Surgery, Zhongshan Hospital Fudan University Shanghai ChinaABSTRACT Background In esophageal cancer, the ypN0 status after induction therapy could be categorized into two primary groups: “natural N0” (cN0/ypN0) and “down‐staged N0” (cN+/ypN0). The assessment of cN status is typically based on clinical imagination or pathological regression. However, there is no standardized method for evaluating cN/ypN status. This study aims to investigate the prognosis of patients with cN+/ypN0 using both assessment methods through a cohort study and meta‐analysis. Methods A prospectively maintained database encompassing esophageal cancer patients undergoing induction therapy followed by radical esophagectomy was comprehensively reviewed. The prognostic significance of cN+/ypN0 across two evaluation methods was quantified. Additionally, a meta‐analysis using data from previous studies was conducted. Results 578 patients were identified from the cohort analysis, with 342 classified as ypN0 and 236 as ypN+. When evaluated with clinical imagination, patients with cN+/ypN0 had survival outcomes comparable to those with natural N0 but significantly better than those with ypN+ (p < 0.001). Using pathological nodal regression, cN+/ypN0 patients showed superior overall survival compared to ypN+ patients (p = 0.0043), although their disease‐free survival was notably inferior to that of natural N0 patients (p = 0.0088). A meta‐analysis of 20 previous studies confirmed the prognostic value of cN+/ypN0 status in both clinical imagination and pathological regression. Conclusions For esophageal cancer patients receiving neoadjuvant, cN+/ypN0 status, assessed through both clinical imagination and pathological regression, serves as a significant prognostic factor. It holds precedence over ypN+ yet falls short of the natural N0. The pre‐treatment categorizations warrant recognition as a novel and pertinent staging metric.https://doi.org/10.1002/cam4.70664esophageal cancerneoadjuvant therapynodal downstagingsurvival |
| spellingShingle | Feng Su Xu Huang Jun Yin Hang Tang Lijie Tan Yaxing Shen Nodal Downstaging of Esophageal Cancer After Neoadjuvant Therapy: A Cohort Study and Meta‐Analysis Cancer Medicine esophageal cancer neoadjuvant therapy nodal downstaging survival |
| title | Nodal Downstaging of Esophageal Cancer After Neoadjuvant Therapy: A Cohort Study and Meta‐Analysis |
| title_full | Nodal Downstaging of Esophageal Cancer After Neoadjuvant Therapy: A Cohort Study and Meta‐Analysis |
| title_fullStr | Nodal Downstaging of Esophageal Cancer After Neoadjuvant Therapy: A Cohort Study and Meta‐Analysis |
| title_full_unstemmed | Nodal Downstaging of Esophageal Cancer After Neoadjuvant Therapy: A Cohort Study and Meta‐Analysis |
| title_short | Nodal Downstaging of Esophageal Cancer After Neoadjuvant Therapy: A Cohort Study and Meta‐Analysis |
| title_sort | nodal downstaging of esophageal cancer after neoadjuvant therapy a cohort study and meta analysis |
| topic | esophageal cancer neoadjuvant therapy nodal downstaging survival |
| url | https://doi.org/10.1002/cam4.70664 |
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