177. BULKY LYMPHADENOPATHY IN ESOPHAGEAL CANCER: ASSESSING PATHOLOGICAL AND SURVIVAL OUTCOMES AFTER TREATMENT WITH CURATIVE INTENT
Bibliographic record
Abstract
Abstract Aim Whilst pre-treatment bulky regional lymphadenopathy is associated with poor survival outcomes in gastric adenocarcinoma, the impact this may have on survival in the setting of esophageal adenocarcinoma has not been described. The aim of this study was to explore the relationship between bulky regional lymphadenopathy found at diagnosis and survival outcomes in patients with esophageal adenocarcinoma treated with neoadjuvant chemotherapy and en bloc esophagogastrectomy. Methods A single center, retrospective review of a prospectively maintained upper GI cancer surgical database was performed between 01/2012 and 12/2020. Patients with adenocarcinoma of the esophagus/esophagogastric junction (cT2–3, Nany, M0) treated with neoadjuvant docetaxel based chemotherapy and transthoracic en bloc esophagogastrectomy were identified. Pretreatment CT scans were reviewed and patients stratified according to whether bulky periesophageal or periceliac lymph nodes were present. This was defined as periceliac or periesophageal lymphadenopathy >2 cm in its long axis. Once stratified by the presence of bulky lymphadenopathy, overall survival (OS) was compared and a Cox multivariate regression model calculated. Results Of the 975 patients identified, 225 met the inclusion criteria. cT3/4 and cN+ was found in 169/225 (75%) and 154/225 (73%) respectively. Forty-eight patients (21%) were allocated to the bulky lymphadenopathy group. Among them, ypT status was similar, ypN3 disease more common (18/48,38% vs 39/177,20%, p = 0.025) with a trend towards pathological complete response (5/48,10% vs 7/177,4%, p = 0.086). OS was worse among patients with bulky regional lymphadenopathy (32.6 vs 50 months, p = 0.012). Along with poor differentiation (HR 1.8,95% CI 1.0–2.9, p = 0.034) and ypN+ (HR 1.9,95% CI 1.1–3.6, p = 0.032), bulky lymphadenopathy was independently associated with an increased risk of death (HR 1.7,1.0–2.9,p = 0.048). Conclusion Pre-treatment bulky regional lymphadenopathy is a poor prognostic sign despite multimodal treatment with docetaxel based systemic neoadjuvant therapy and en bloc resection. Identification of alternative treatment strategies may help improve survival outcomes among this specific group of patients.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.001 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".