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The prognosis of patients with locally advanced esophageal squamous cell carcinoma with different recurrence backgrounds is highly heterogeneous. This study aims to explore the effects of recurrence patterns on prognosis.The phase III, multicenter, prospective NEOCRTEC5010 trial enrolled 451 patients with stage IIB-III esophageal squamous cell carcinoma randomly assigned to neoadjuvant chemoradiotherapy combined with surgery (NCRT group) or surgery alone (S group) and followed them long-term. We investigated the effects of recurrence patterns on survival in patients undergoing radical esophagectomy.In total, 353 patients were included in the study. The 5-year overall survival of patients with different recurrence patterns was significantly different: recurrence versus recurrence-free (17.8% vs 89.2%; P .001), early recurrence versus late recurrence (4.6% vs 51.2%; P .001), and distant metastasis versus locoregional recurrence (17.0% vs 20.0%; P = .666). Patients with early recurrence had significantly shorter survival after recurrence than those with late recurrence (hazard ratio, 1.541; 95% confidence interval, 1.047-2.268, P = .028). There was no significant difference in postrecurrence survival between patients with distant metastasis and locoregional recurrence (hazard ratio, 1.181; 95% confidence interval, 0.804-1.734; P = .396). Multivariate logistic analysis showed that pN1 stage, lymph node dissection20, and lack of response to NCRT were independent risk factors for postoperative early recurrence. Multivariate Cox regression suggested that NCRT, age ≥60 years, early recurrence, and the pN1 stage were independent risk factors for shortened survival after recurrence.Prerecurrence primary tumor stage is inaccurate in predicting postrecurrence survival. In contrast, recurrence patterns can guide follow-up while also predicting postrecurrence survival. NCRT prolongs disease-free survival but is associated with a worse prognosis in patients with recurrence, especially early recurrence.

Structured Abstract Objective Accurate nodal staging is crucial for esophageal cancer. A prospective study was performed to assess the value of [18F] fluorodeoxyglucose (FDG) positron emission tomography (PET)/computed tomography (CT) for diagnosing cervical lymph node metastasis (LNM) of esophageal squamous cell carcinoma. Methods From June 2018 to November 2018, 110 patients with resectable esophageal cancer were prospectively enrolled. Esophagectomy with three-field lymphadenectomy were performed after FDG-PET/CT scanning. The primary end-point was cervical LNM determined via postoperative histological examination. The sensitivity (SE), specificity (SP), positive predictive value (PPV), negative predictive value (NPV), and accuracy (AC) of FDG-PET/CT for the assessment of LNM were determined using histological results as reference standards. Results Positive lymph nodes as determined via FDG-PET/CT were detected in 61 patients (55.5%), of which 13 (11.8%) had positive cervical lymph nodes. After surgery, 59 patients (53.6%) exhibited pathological LNM, of which 20 (18.2%) had cervical LNM. SE, SP, PPV, NPV and AC were 65.6%, 61.2%, 67.8%, 58.8%, and 63.6%, respectively, with regards to diagnosing overall LNM, and were 45.0%, 95.6%, 69.2%, 88.7%, and 86.4%, respectively, for diagnosing cervical LNM. Of the 110 patients, 90 underwent both FDG-PET/CT scanning and ultrasonography in the neck, and there were no significant differences in SE, SP, PPV, NPV or AC with respect to cervical LNM diagnosis between FDG-PET/CT and ultrasonography. Conclusion For cervical LNM of esophageal squamous cell carcinoma, FDG-PET/CT scanning exhibited high specificity but low sensitivity, suggesting that it is of limited value for this purpose.

ObjectivesLymph node metastasis is among the most important prognostic factors for patients with esophageal squamous cell carcinoma after curative esophagectomy; however, the extent of lymphadenectomy is still controversial. The objective of the present study was to determine the frequency of lymphatic metastases and to study the pattern of lymph node metastasis in a large study population.MethodsThe data from 1361 patients with thoracic esophageal squamous cell carcinoma who underwent curative R0 esophagectomy were retrospectively examined. Logistic regression analysis was used to identify the factors associated with lymph node metastasis.ResultsOf the 1361 patients, 714 (52.5%) were found to have lymph node metastasis. The frequency of lymph node metastasis increased as the tumor invasion increased. Paratracheal nodes were the most frequent metastasis nodes (15.9%). The frequency of lymph node metastasis was 9.8% in the neck, 18.0% in the upper mediastinum, 18.9% in the middle mediastinum, 11.8% in the lower mediastinum, and 28.4% in the abdomen. Of these 714 patients, 424 (31.2%) presented with 1 field involvement, 255 (18.7%) with 2 fields, and 35 (2.6%) with 3 fields involvement. Logistic regression analysis revealed tumor length (P

Objective Methods to minimize surgical trauma from mediastinal lymphadenectomy in patients with early-stage lung cancer are still immature. This study aimed to identify predictors of negative pathologic N2, which may be used to select patients for limited mediastinal lymphadenectomy. Methods Clinicopathologic features of 1430 patients with resected clinical stage I non–small cell lung cancer and complete mediastinal lymphadenectomy were retrospectively analyzed for variables associated with negative N2 nodal metastasis (2008-2015). Overall and recurrence-free survival in patients after complete or limited mediastinal lymphadenectomy were assessed via Kaplan–Meier survival analysis and log-rank testing. The accuracy of frozen section diagnosis for predicting final pathology was retrospectively assessed in 126 randomly selected patients after the surgery. Results Multivariable analysis revealed that tumor size ≤2 cm, negative pN1, lymphovascular invasion, and lepidic adenocarcinoma were associated with negative mediastinal nodal metastasis. Notably, none of the patients with histology of adenocarcinoma in situ, minimally invasive adenocarcinoma, or lepidic pattern–predominant adenocarcinoma on final pathology had pN2 disease, and the 5-year overall and recurrence free-survival of these patients (99.3% and 99.3%, respectively) was not different from those after limited mediastinal lymphadenectomy (98.7% and 100%, P = .582 and .511, respectively). If these subtypes were classified together as the low-risk group, the concordance rate between frozen section and final pathology diagnosis was 88.9% in the retrospective test cohort. Conclusions Tumor histology may predict negative mediastinal metastasis in patients with early-stage lung cancer. Future prospective studies are merited to validate the feasibility of using frozen section to select patients for limited mediastinal lymphadenectomy.

Objective Surgery plays an important role in the multidisciplinary treatment strategy for patients with stage IIIA non–small cell lung cancer (NSCLC). Besides induction therapy, patients could benefit from surgery followed by adjuvant chemotherapy and radiotherapy. This study analyzed a subset of patients with pIIIA NSCLC who underwent upfront surgery as first-line therapy. Methods Selected patients with pIIIA NSCLC who received upfront surgery were retrospectively analyzed. Clinicopathologic characteristics and survival outcomes including progression-free survival (PFS) and overall survival (OS) were evaluated. Results A total of 668 patients were identified. Five hundred sixty-five patients received adjuvant chemotherapy, and 157 patients received adjuvant radiotherapy after surgery. The median PFS and OS were 17.0 and 44.0 months, respectively. The 3-year and 5-year PFS rates were 31.6% and 21.0%, and the 3-year and 5-year OS rates were 54.7% and 43.0%. Patients with adenocarcinoma (AD) had better OS than those with squamous cell carcinoma (5-year OS: P = .026). Patients with low-grade AD (acinar and papillar) had a similar PFS and OS compared with patients with high-grade AD (solid, micropapillary, and mucinous) (5-year PFS: P = .894; 5-year OS: P = .439). Patients with mutated epidermal growth factor receptor had a similar OS to patients with wild-type epidermal growth factor receptor (5-year OS: P = .121). Patients with clinical N0 status (P = .004) and patients with single-station of pathologic N2 (P Conclusions Upfront surgery followed by adjuvant therapy may provide favorable survival outcomes for selected patients with pIIIA NSCLC, especially for patients with AD or patients with clinical N0 and pathologic single-station N2 diseases.

Objective Controversy remains over the appropriate postoperative management for patients with stage Ia non–small cell lung cancer who underwent complete surgical resection as a result of a heterogeneous prognosis. We aimed to identify the predictive factors for recurrence in these patients to aid in the decision making. Methods We reviewed 344 patients with stage Ia non–small cell lung cancer to analyze the associations between recurrence-free survival and the following clinicopathologic variables: age, gender, smoking history, family history, preoperative serum carcinoembryonic antigen level, type of surgical resection, tumor location, tumor histology, lymphovascular invasion, tumor differentiation, and pathologic T status. Results Cox multivariate survival analysis revealed that central tumor location ( P = .019), stage T1b ( P = .006), high histologic grade (including large cell carcinoma, solid predominant, micropapillary predominant, and invasive mucinous adenocarcinoma, P = .007), poor differentiation ( P = .022), and lymphovascular invasion ( P = .035) were independently associated with recurrence-free survival. A nomogram for predicting the probability of 3-year recurrence-free survival was developed using the 5 variables. This model shows good calibration, reasonable discrimination (concordance index = 0.733), and small overfitting (2.6%) demonstrated by bootstrapping. Conclusions We developed a clinicopathologic prediction model for postoperative recurrence in stage Ia non–small cell lung cancer. This model can help with the selection of appropriate postoperative therapeutic strategies for these patients.

Objective Controversy remains over the routine use of mediastinoscopy or positron emission tomography in T1 non–small cell lung cancer without lymph node enlargement on computed tomography because the risk of N2 involvement is comparatively low. We aimed to develop a prediction model for N2 disease in cT1N0 non–small cell lung cancer to aid in the decision-making process. Methods We reviewed the records of 530 patients with computed tomography–defined T1N0 non–small cell lung cancer who underwent surgical resection with systematic lymph node dissection. Correlations between N2 involvement and clinicopathologic parameters were assessed using univariate analysis and binary logistic regression analysis. A prediction model was built on the basis of logistic regression analysis and was internally validated using bootstrapping. Results The incidence of N2 disease was 16.8%. Four independent predictors were identified in multivariate logistic regression analysis and included in the prediction model: younger age at diagnosis (odds ratio, 0.974; 95% confidence interval, 0.952-0.997), larger tumor size (odds ratio, 2.769; 95% confidence interval, 1.818-4.217), central tumor location (odds ratio, 3.204; 95% confidence interval, 1.512-6.790), and invasive adenocarcinoma histology (odds ratio, 3.537; 95% confidence interval, 1.740-7.191). This model shows good calibration (Hosmer–Lemeshow test: P = .784), reasonable discrimination (area under the receiver operating characteristic curve, 0.726; 95% confidence interval, 0.669-0.784), and minimal overfitting demonstrated by bootstrapping. Conclusions We developed a 4-predictor model that can estimate the probability of N2 disease in computed tomography–defined T1N0 non–small cell lung cancer. This prediction model can help to determine the cost-effective use of mediastinal staging procedures.