Objectives: Oesophageal adenocarcinoma has a poor prognosis and relies on multi-modality assessment for accurate nodal staging. The aim of the study was to determine the prognostic significance of nodal concordance between PET/CT and EUS in oesophageal adenocarcinoma.
Methods: Consecutive patients with oesophageal adenocarcinoma staged between 2010 and 2016 were included. Groups comprising concordant node-negative (C-ve), discordant (DC), and concordant node-positive (C+ve) patients were analysed. Survival analysis using log-rank tests and Cox proportional hazards model was performed. The primary outcome was overall survival. A p value < 0.05 was considered statistically significant.
Results: In total, 310 patients (median age = 66.0; interquartile range 59.5-72.5, males = 264) were included. The median overall survival was 23.0 months (95% confidence intervals (CI) 18.73-27.29). There was a significant difference in overall survival between concordance groups (X2 = 44.91, df = 2, p < 0.001). The hazard ratios for overall survival of DC and C+ve patients compared with those of C-ve patients with cT3 tumours were 1.21 (95% CI 0.81-1.79) and 1.79 (95% CI 1.23-2.61), respectively. On multivariable analysis, nodal concordance was significantly and independently associated with overall survival (HR 1.44, 95% CI 1.12-1.83, p = 0.004) and performed better than age at diagnosis (HR 1.02, 95% CI 1.003-1.034, p = 0.016) and current cN-staging methods (HR 1.20, 95% CI 0.978-1.48, p = 0.080).
Conclusions: Patients with discordant nodal staging on PET/CT and EUS represent an intermediate-risk group for overall survival. This finding was consistent in patients with cT3 tumours. These findings will assist optimum treatment decisions based upon perceived prognosis for each patient.
Key points: • Clinicians are commonly faced with results of discordant nodal staging in oesophageal adenocarcinoma. • There is a significant difference in overall survival between patients with negative, discordant, and positive lymph node staging. • Patients with discordant lymph node staging between imaging modalities represent an intermediate-risk group for overall survival.
Keywords: Endosonography; Lymph node; Neoplasm staging; Oesophageal neoplasm; Positron emission tomography.