{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,12]],"date-time":"2025-10-12T20:18:31Z","timestamp":1760300311911},"reference-count":21,"publisher":"Springer Science and Business Media LLC","issue":"4","license":[{"start":{"date-parts":[[2019,11,5]],"date-time":"2019-11-05T00:00:00Z","timestamp":1572912000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2019,11,5]],"date-time":"2019-11-05T00:00:00Z","timestamp":1572912000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Ann Surg Oncol"],"published-print":{"date-parts":[[2020,4]]},"abstract":"<jats:title>Abstract<\/jats:title>\n<jats:sec>\n<jats:title>Background<\/jats:title>\n<jats:p>This study was conducted to validate a pretreatment (i.e. prior to neoadjuvant chemoradiotherapy) pathological staging system in the resection specimen after neoadjuvant chemoradiotherapy for esophageal cancer. The study investigated the prognostic value of pretreatment pathological T and N categories (prepT and prepN categories) in both an independent and a combined patient cohort.<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>Methods<\/jats:title>\n<jats:p>Patients with esophageal cancer treated with neoadjuvant chemotherapy and esophagectomy between 2012 and 2015 were included. PrepT and prepN categories were estimated based on the extent of tumor regression and regressional changes of lymph nodes in the resection specimen. The difference in Akaike\u2019s information criterion (\u0394AIC) was used to assess prognostic performance. PrepN and ypN categories were combined to determine the effect of nodal sterilization on prognosis. A multivariable Cox regression model was used to identify combined prepN and ypN categories as independent prognostic factors.<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>Results<\/jats:title>\n<jats:p>The prognostic strength of the prepT category was better than the cT and ypT categories (\u0394AIC 7.7 vs. 3.0 and 2.9, respectively), and the prognostic strength of the prepN category was better than the cN category and similar to the ypN category (\u0394AIC 29.2 vs. \u2212\u20091.0 and 27.9, respectively). PrepN\u2009+\u2009patients who became ypN0 had significantly worse survival than prepN0 patients (2-year overall survival 69% vs. 86% in 137 patients; <jats:italic>p\u2009<\/jats:italic>=\u20090.044). Similar results were found in a combined cohort of 317 patients (2-year overall survival 62% vs. 85%; <jats:italic>p\u2009<\/jats:italic>=\u20090.002). Combined prepN\/ypN stage was independently associated with overall survival.<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>Conclusions<\/jats:title>\n<jats:p>These results independently confirm the prognostic value of prepTNM staging. PrepTNM staging is of additional prognostic value to cTNM and ypTNM. PrepN0\/ypN0 patients have a better survival than prepN\u2009+\/ypN0 patients.<\/jats:p>\n<\/jats:sec>","DOI":"10.1245\/s10434-019-08024-0","type":"journal-article","created":{"date-parts":[[2019,11,5]],"date-time":"2019-11-05T20:02:54Z","timestamp":1572984174000},"page":"1250-1258","update-policy":"http:\/\/dx.doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":8,"title":["External Validation of Pretreatment Pathological Tumor Extent in Patients with Neoadjuvant Chemoradiotherapy Plus Surgery for Esophageal Cancer"],"prefix":"10.1245","volume":"27","author":[{"given":"Sebastian","family":"Brinkmann","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bo J.","family":"Noordman","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Arnulf H.","family":"H\u00f6lscher","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Katharina","family":"Biermann","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"David","family":"van Klaveren","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Elfriede","family":"Bollschweiler","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Katharina","family":"P\u00fctz","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"J. Jan B.","family":"van Lanschot","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Uta","family":"Drebber","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2019,11,5]]},"reference":[{"issue":"5","key":"8024_CR1","doi-asserted-by":"publisher","first-page":"779","DOI":"10.1097\/SLA.0000000000000964","volume":"260","author":"AH Holscher","year":"2014","unstructured":"Holscher AH, Drebber U, Schmidt H, Bollschweiler E. Prognostic classification of histopathologic response to neoadjuvant therapy in esophageal adenocarcinoma. Ann Surg. 2014;260(5):779\u201384 (discussion 784\u20135).","journal-title":"Ann Surg."},{"issue":"6","key":"8024_CR2","doi-asserted-by":"publisher","first-page":"902","DOI":"10.1097\/SLA.0b013e31818f3afb","volume":"248","author":"PM Schneider","year":"2008","unstructured":"Schneider PM, Metzger R, Schaefer H et al. Response evaluation by endoscopy, rebiopsy, and endoscopic ultrasound does not accurately predict histopathologic regression after neoadjuvant chemoradiation for esophageal cancer. Ann Surg. 2008;248(6):902\u20138.","journal-title":"Ann Surg."},{"issue":"5","key":"8024_CR3","doi-asserted-by":"publisher","first-page":"784","DOI":"10.1097\/SLA.0b013e3182a66588","volume":"258","author":"Claire L. Donohoe","year":"2013","unstructured":"Donohoe CL, O\u2019Farrell NJ, Grant T et al. Classification of pathologic response to neoadjuvant therapy in esophageal and junctional cancer: assessment of existing measures and proposal of a novel 3-point standard. Ann Surg. 2013;258:784\u201392.","journal-title":"Annals of Surgery"},{"issue":"6","key":"8024_CR4","doi-asserted-by":"publisher","first-page":"2020","DOI":"10.1016\/j.athoracsur.2011.06.091","volume":"92","author":"E Bollschweiler","year":"2011","unstructured":"Bollschweiler E, Holscher AH, Metzger R et al. Prognostic significance of a new grading system of lymph node morphology after neoadjuvant radiochemotherapy for esophageal cancer. Ann Thorac Surg. 2011;92(6):2020\u20137.","journal-title":"Ann Thorac Surg."},{"issue":"2","key":"8024_CR5","doi-asserted-by":"publisher","first-page":"356","DOI":"10.1097\/SLA.0000000000001630","volume":"265","author":"J Shapiro","year":"2017","unstructured":"Shapiro J, Biermann K, van Klaveren D et al. Prognostic value of pretreatment pathological tumor extent in patients treated with neoadjuvant chemoradiotherapy plus surgery for esophageal or junctional cancer. Ann Surg. 2017;265(2):356\u201362.","journal-title":"Ann Surg."},{"issue":"3","key":"8024_CR6","doi-asserted-by":"publisher","first-page":"547","DOI":"10.1038\/sj.bjc.6604200","volume":"98","author":"EP van Vliet","year":"2008","unstructured":"van Vliet EP, Heijenbrok-Kal MH, Hunink MG, Kuipers EJ, Siersema PD. Staging investigations for oesophageal cancer: a meta-analysis. Br J Cancer. 2008;98(3):547\u201357.","journal-title":"Br J Cancer."},{"key":"8024_CR7","unstructured":"Sobin LH, Gospodarowicz MK, Wittekind C, International Union against Cancer, ebrary Inc. TNM classification of malignant tumors. New York: Wiley-Blackwell; 2009. \nhttp:\/\/site.ebrary.com\/lib\/yale\/Doc?id=10342913\n\n. Accessed 29 Jan 2018."},{"issue":"9","key":"8024_CR8","doi-asserted-by":"publisher","first-page":"1090","DOI":"10.1016\/S1470-2045(15)00040-6","volume":"16","author":"J Shapiro","year":"2015","unstructured":"Shapiro J, van Lanschot JJ, Hulshof MC et al. Neoadjuvant chemoradiotherapy plus surgery versus surgery alone for oesophageal or junctional cancer (CROSS): long-term results of a randomised controlled trial. Lancet Oncol. 2015;16(9):1090\u20138.","journal-title":"Lancet Oncol."},{"issue":"22","key":"8024_CR9","doi-asserted-by":"publisher","first-page":"2074","DOI":"10.1056\/NEJMoa1112088","volume":"366","author":"P van Hagen","year":"2012","unstructured":"van Hagen P, Hulshof MC, van Lanschot JJ et al. Preoperative chemoradiotherapy for esophageal or junctional cancer. N Engl J Med. 2012;366(22):2074\u201384.","journal-title":"N Engl J Med."},{"issue":"2","key":"8024_CR10","doi-asserted-by":"publisher","first-page":"241","DOI":"10.1097\/01.sla.0000245847.40779.10","volume":"245","author":"AH Holscher","year":"2007","unstructured":"Holscher AH, Schneider PM, Gutschow C, Schroder W. Laparoscopic ischemic conditioning of the stomach for esophageal replacement. Ann Surg. 2007;245(2):241\u20136.","journal-title":"Ann Surg."},{"issue":"4","key":"8024_CR11","doi-asserted-by":"publisher","first-page":"738","DOI":"10.1007\/s00268-010-0403-x","volume":"34","author":"W Schroder","year":"2010","unstructured":"Schroder W, Holscher AH, Bludau M, Vallbohmer D, Bollschweiler E, Gutschow C. Ivor-Lewis esophagectomy with and without laparoscopic conditioning of the gastric conduit. World J Surg. 2010;34(4):738\u201343.","journal-title":"World J Surg."},{"issue":"5","key":"8024_CR12","doi-asserted-by":"publisher","first-page":"684","DOI":"10.1097\/01.sla.0000186170.38348.7b","volume":"242","author":"PM Schneider","year":"2005","unstructured":"Schneider PM, Baldus SE, Metzger R et al. Histomorphologic tumor regression and lymph node metastases determine prognosis following neoadjuvant radiochemotherapy for esophageal cancer: implications for response classification. Ann Surg. 2005;242(5):684\u201392.","journal-title":"Ann Surg."},{"issue":"11","key":"8024_CR13","doi-asserted-by":"publisher","first-page":"2680","DOI":"10.1002\/1097-0142(19940601)73:11<2680::AID-CNCR2820731105>3.0.CO;2-C","volume":"73","author":"AM Mandard","year":"1994","unstructured":"Mandard AM, Dalibard F, Mandard JC et al. Pathologic assessment of tumor regression after preoperative chemoradiotherapy of esophageal carcinoma. Clinicopathologic correlations. Cancer. 1994;73(11):2680\u20136.","journal-title":"Cancer."},{"issue":"9","key":"8024_CR14","doi-asserted-by":"publisher","first-page":"1108","DOI":"10.1046\/j.1365-2168.1999.01209.x","volume":"86","author":"JM Wheeler","year":"1999","unstructured":"Wheeler JM, Warren BF, Jones AC, Mortensen NJ. Preoperative radiotherapy for rectal cancer: implications for surgeons, pathologists and radiologists. Br J Surg. 1999;86(9):1108\u201320.","journal-title":"Br J Surg."},{"key":"8024_CR15","doi-asserted-by":"publisher","first-page":"716","DOI":"10.1109\/TAC.1974.1100705","volume":"19","author":"H Akaike","year":"1974","unstructured":"Akaike H. A new look at the statistical model identification. IEEE Trans Autom Control. 1974;19:716\u201323.","journal-title":"IEEE Trans Automat Contr"},{"issue":"4","key":"8024_CR16","first-page":"342","volume":"25","author":"SP Monig","year":"2002","unstructured":"Monig SP, Schroder W, Baldus SE, Holscher AH. Preoperative lymph-node staging in gastrointestinal cancer\u2013correlation between size and tumor stage. Onkologie. 2002;25(4):342\u20134.","journal-title":"Onkologie"},{"issue":"8","key":"8024_CR17","doi-asserted-by":"publisher","first-page":"693","DOI":"10.1016\/j.crad.2017.02.022","volume":"72","author":"KG Foley","year":"2017","unstructured":"Foley KG, Christian A, Fielding P, Lewis WG, Roberts SA. Accuracy of contemporary oesophageal cancer lymph node staging with radiological-pathological correlation. Clin Radiol. 2017;72(8):693 (e1\u2013e7).","journal-title":"Clin Radiol."},{"issue":"4","key":"8024_CR18","doi-asserted-by":"publisher","first-page":"325","DOI":"10.1055\/s-2007-966233","volume":"39","author":"EP van Vliet","year":"2007","unstructured":"van Vliet EP, Eijkemans MJ, Kuipers EJ, Poley JW, Steyerberg EW, Siersema PD. Publication bias does not play a role in the reporting of the results of endoscopic ultrasound staging of upper gastrointestinal cancers. Endoscopy. 2007;39(4):325\u201332.","journal-title":"Endoscopy."},{"issue":"1","key":"8024_CR19","doi-asserted-by":"publisher","first-page":"277","DOI":"10.1016\/j.athoracsur.2014.07.037","volume":"99","author":"DR Nieman","year":"2015","unstructured":"Nieman DR, Peyre CG, Watson TJ et al. Neoadjuvant treatment response in negative nodes is an important prognosticator after esophagectomy. Ann Thorac Surg. 2015;99(1):277\u201383.","journal-title":"Ann Thorac Surg."},{"issue":"5","key":"8024_CR20","doi-asserted-by":"publisher","first-page":"1687","DOI":"10.1016\/j.athoracsur.2016.05.026","volume":"102","author":"HY Hsu","year":"2016","unstructured":"Hsu HY, Chao YK, Hsieh CH et al. Postoperative adjuvant therapy improves survival in pathologic nonresponders after neoadjuvant chemoradiation for esophageal squamous cell carcinoma: a propensity-matched analysis. Ann Thorac Surg. 2016;102(5):1687\u201393.","journal-title":"Ann Thorac Surg."},{"issue":"4","key":"8024_CR21","doi-asserted-by":"publisher","first-page":"314","DOI":"10.1016\/j.ejso.2012.01.007","volume":"38","author":"KL Prenzel","year":"2012","unstructured":"Prenzel KL, Holscher AH, Drebber U, Agavonova M, Gutschow CA, Bollschweiler E. Prognostic impact of nodal micrometastasis in early esophageal cancer. Eur J Surg Oncol. 2012;38(4):314\u20138.","journal-title":"Eur J Surg Oncol."}],"container-title":["Annals of Surgical Oncology"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/link.springer.com\/content\/pdf\/10.1245\/s10434-019-08024-0.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"http:\/\/link.springer.com\/article\/10.1245\/s10434-019-08024-0\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"http:\/\/link.springer.com\/content\/pdf\/10.1245\/s10434-019-08024-0.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2020,11,4]],"date-time":"2020-11-04T00:06:23Z","timestamp":1604448383000},"score":1,"resource":{"primary":{"URL":"http:\/\/link.springer.com\/10.1245\/s10434-019-08024-0"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2019,11,5]]},"references-count":21,"journal-issue":{"issue":"4","published-print":{"date-parts":[[2020,4]]}},"alternative-id":["8024"],"URL":"https:\/\/doi.org\/10.1245\/s10434-019-08024-0","relation":{},"ISSN":["1068-9265","1534-4681"],"issn-type":[{"value":"1068-9265","type":"print"},{"value":"1534-4681","type":"electronic"}],"subject":[],"published":{"date-parts":[[2019,11,5]]},"assertion":[{"value":"1 March 2019","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"5 November 2019","order":2,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"The authors declare that they have no conflict of interest.","order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Disclosure"}}]}}