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. 2025 Jul 31;17(7):5044-5054.
doi: 10.21037/jtd-2025-172. Epub 2025 Jul 29.

The impact of extended lymphadenectomy on survival in esophageal adenocarcinoma with complete pathologic response: a retrospective study

Megan E Campany #  1   2 , Britton B Donato #  3 , Song Kim  4 , Jason M Long  1 , Staci E Beamer  5 , Mario Gasparri  3 , Paul Linsky  3
Affiliations

The impact of extended lymphadenectomy on survival in esophageal adenocarcinoma with complete pathologic response: a retrospective study

Megan E Campany et al. J Thorac Dis. .

Abstract

Background: The impact of extended lymphadenectomy in esophageal adenocarcinoma (EAC) has been established in recent literature. The role of lymph node harvest in those achieving a complete pathologic response (CPR) is less clear. We aim to further investigate the impact of extended lymphadenectomy on survival in those patients with CPR.

Methods: The National Cancer Database (NCDB) was queried from 2006-2021 for patients with EAC without distant metastasis who received trimodal therapy. Groups of <10, 10-20, and >20 nodes harvested were established. Multivariable Cox regression and Kaplan-Meier survival analyses were conducted.

Results: Of 17,292 patients identified, 20.51% (n=3,547) had CPR. Multivariable analysis identified extended lymphadenectomy as an independent prognostic factor for survival in those with CPR [10-20 nodes, hazard ratio (HR) 0.847, P=0.03; >20 nodes, HR 0.768, P=0.01]. Median survival was longer in the 10-20 nodes (91.70 months) and >20 nodes (81.15 months) groups compared to the <10 nodes group (59.70 months, P=0.03), but similar between the 10-20 and >20 nodes groups (P=0.84). Analysis by clinical stage (cSTAGE) revealed no survival benefit with increasing nodal harvest in cSTAGE I (P=0.25) or cSTAGE II (P=0.12) disease. In those with cSTAGE III disease, increased nodal harvest served as an independent prognostic factor for survival (10-20 nodes HR 0.811, P=0.03; >20 nodes, HR 0.770, P=0.02). Median survival improved with 10-20 nodes (84.21 months) compared to <10 nodes (53.32 months, P=0.03) but not further with >20 nodes (74.64 months, P=0.74).

Conclusions: These results suggest that the benefit of lymphadenectomy in those with CPR may be stage dependent. In our cohort, only those with cSTAGE III disease saw a benefit from a greater than >10 nodes harvest and no groups derived additional benefit from more extended lymphadenectomy (>20 nodes).

Keywords: Esophageal cancer; complete pathologic response (CPR); lymph node metastases; lymphadenectomy.

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Conflict of interest statement

Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://jtd.amegroups.com/article/view/10.21037/jtd-2025-172/coif). The authors have no conflicts of interest to declare.

Figures

Figure 1
Figure 1
Survival in all EAC patients with CPR by lymph node harvest. CPR, complete pathologic response; EAC, esophageal adenocarcinoma.
Figure 2
Figure 2
Survival in cSTAGE I EAC with CPR by lymph node harvest. CPR, complete pathologic response; cSTAGE, clinical stage; EAC, esophageal adenocarcinoma.
Figure 3
Figure 3
Survival in cSTAGE II EAC with CPR by lymph node harvest. CPR, complete pathologic response; cSTAGE, clinical stage; EAC, esophageal adenocarcinoma.
Figure 4
Figure 4
Survival in cSTAGE III EAC with CPR by lymph node harvest. CPR, complete pathologic response; cSTAGE, clinical stage; EAC, esophageal adenocarcinoma.
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