Abstract
Background
Accurate clinical evaluation of lymph nodes is crucial for selection of the optimum treatment strategy for individual esophageal cancer patients. This study investigated the accuracy of preoperative clinical diagnosis of lymph node metastasis for patients with clinical stage II/III esophageal squamous cell carcinoma.
Methods
Patients assigned to receive surgery and postoperative chemotherapy in JCOG9907 trial were studied to evaluate the concordance between clinical and pathological nodes. Preoperative diagnosis was based on computed tomography or magnetic resonance imaging.
Results
Among 166 patients in the postoperative group, 160 with sufficient pathological data were studied. The patient background characteristics were: male/female, 147/13; median age, 61 years (range 39–75 years); primary tumor site (upper/middle/lower), 15/76/69; cN0/cN1, 53/107. The sensitivity and specificity of clinical nodes for diagnosis of pathological nodes were 72.7 and 51.3 %, respectively; the positive and negative predictive values were 82.2 and 37.7 %, respectively. The lymph nodes overestimated in the preoperative diagnosis included thoracic paratracheal lymph nodes (#106) (n = 8), middle thoracic paraesophageal lymph nodes (#108) (n = 4), lymph nodes along the lesser curvature (#3) (n = 4), right cardiac lymph nodes (#1) (n = 3), and left cardiac lymph nodes (#2) (n = 2).
Conclusion
Diagnosis of clinical nodes has low specificity and low negative predictive value for prediction of pathological node category in the preoperative diagnosis of lymph node metastasis for patients with locally advanced resectable esophageal cancer. Clinical staging techniques must therefore be improved for accurate preoperative diagnosis.
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Acknowledgments
The authors are grateful to the members of the JCOG Data Center and the JCOG Operations Office for their support in preparing the manuscript, statistical analysis, data management, and study management. JCOG9907 was supported in part by Grants-in-Aid for Cancer Research (14S-3, 14S-4, 17S-3, 17S-5, 20S-3, and 20S-6) from the Ministry of Health, Labour, and Welfare of Japan, and the National Cancer Center Research and Development Fund (23-A-16, 23-A-21, and 26-A-4) of Japan.
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Dr. Yuko Kitagawa has received honoraria from Nippon Kayaku Co., Ltd and Kyowa Hakko Kirin Co., Ltd. Dr. Yuko Kitagawa has received research funding from Nippon Kayaku Co., Ltd, Kyowa Hakko Kirin Co., Ltd, Bristol–Myers Squibb, and Pfizer Co., Ltd.
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Yokota, T., Igaki, H., Kato, K. et al. Accuracy of preoperative diagnosis of lymph node metastasis for thoracic esophageal cancer patients from JCOG9907 trial. Int J Clin Oncol 21, 283–288 (2016). https://doi.org/10.1007/s10147-015-0899-z
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DOI: https://doi.org/10.1007/s10147-015-0899-z