Discordant nodal staging identifies intermediate-risk group for overall survival in patients with cT3 oesophageal adenocarcinoma

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 (X(2) = 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. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1007/s00330-019-06642-6) contains supplementary material, which is available to authorized users.