Cancer Research and Treatment

Original Articles

Trajectory of Lymph Node Metastasis Reflects the Molecular Features of Esophageal Squamous Cell Carcinoma: Jiho Park, Seong Yong Park, Ha Eun Kim, Se-Young Jo, JeongSoo Won, Dae Joon Kim, Sangwoo Kim; Received March 5, 2025 Accepted October 14, 2025 Published online October 15, 2025; DOI: https://doi.org/10.4143/crt.2025.257 [Accepted]

Abstract PDF: Purpose
Esophageal squamous cell carcinoma (ESCC) is frequently accompanied by lymph node metastasis (LNM) to the neck, chest, and abdomen. Despite its significance as a key prognostic factor, the genomic trajectory of LNM remains poorly understood. This study aimed to characterize the underlying patterns and genomic characteristics of LNM.
Materials and Methods
Whole-exome sequencing and transcriptome sequencing were performed on 45 multiregional samples (10 primary tumors, 10 normal esophageal tissues, and 25 lymph node tumors) from 10 ESCC patients who underwent esophagectomy with three-field lymphadenectomy. The temporal trajectory of metastasis was reconstructed through phylogenetic analysis, leveraging somatic mutations identified in the primary tumor and lymph nodes.
Results
Somatic mutations preceding metastasis included major driver mutations, such as TP53 and KMT2D, and displayed a mutational process associated with alcohol consumption (SBS16), emphasizing its influence on early tumorigenesis. In contrast, post-lymph node metastatic mutations were sporadic. Lymph nodes seeded later acquired mutations at a faster rate, suggesting increased genomic instability. In three of nine patients (33%), nodal skip metastasis (NSM) was observed, including two cases detected exclusively via genomic analysis, highlighting the necessity of phylogenetic assessment to avoid misclassification. Transcriptome analysis revealed activation of epithelial-mesenchymal transition and KRAS signaling pathways in NSM tumors, indicative of poor prognostic outcomes.
Conclusion
Our study provides a molecular understanding of LNM, emphasizes the potential importance of node-skipping patterns in ESCC, and underscores the utility of genomic analysis in elucidating the connection between LNM.

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Trends and Outcomes of Lung Cancer Surgery in South Korea: Joon Beom Park, Su-Jin Cho, Myung-Il Hahm, Danbee Kang, Seong Yong Park; Received March 14, 2025 Accepted May 24, 2025 Published online May 27, 2025; DOI: https://doi.org/10.4143/crt.2025.295 [Accepted]

Abstract PDF Supplementary Material: Purpose
This study analyzed nationwide trends in lung cancer surgery in South Korea over 14 years, focusing on surgical volume, patient demographics, surgical approaches, and outcomes.
Materials and Methods
We performed a retrospective cohort study using nationwide health insurance claims data (124,334 cases) and robotic surgery data (1,740 cases) provided by the manufacturer. Patients who underwent lung cancer surgery between 2010 and 2023 were included. Annual trends were assessed using the annual percentage change (APC), and logistic as well as linear regression models were used to identify predictors of mortality and prolonged hospital stay.
Results
The annual surgical volume increased from 4,557 in 2010 to 14,184 in 2023 (APC, 8.86%; p<0.001). Video-assisted thoracoscopic surgery (VATS) became the predominant approach, rising from 52.9% to 94.8% (APC, 4.11%; p<0.001). Sub-lobar resections increased, with wedge resections growing from 8.2% to 18.5% (APC, 5.72%; p<0.001) and segmentectomies from 4.2% to 9.6% (APC, 7.48%; p<0.001). The proportion of female patients increased from 32.0% to 44.7% (APC, 2.39%; p<0.001), while patients aged 70–79 years increased from 26.3% to 32.3% (APC, 1.60%; p<0.001) and those aged ≥80 years from 2.0% to 6.2% (APC, 9.63%; p<0.001). The median hospital stay decreased from 13 to 7 days (APC, -4.34%; p<0.001), and 30-day mortality declined from 2.45% to 0.76% (APC, -8.32%; p<0.001).
Conclusion
Lung cancer surgery in Korea has increased substantially, with a notable shift toward minimally invasive and lung-sparing techniques that have improved outcomes. However, persistent disparities underscore the need for a national surgical registry.

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Gastrointestinal cancer

The Role of Adjuvant Chemotherapy after Neoadjuvant Chemoradiotherapy Followed by Surgery in Patients with Esophageal Squamous Cell Carcinoma: Seong Yong Park, Hong Kwan Kim, Yeong Jeong Jeon, Junghee Lee, Jong Ho Cho, Yong Soo Choi, Young Mog Shim, Jae Il Zo; Cancer Res Treat. 2023;55(4):1231-1239. Published online April 24, 2023; DOI: https://doi.org/10.4143/crt.2022.1417

Abstract PDF Supplementary Material PubReader ePub

Purpose
This study aimed to investigate the efficacy of adjuvant chemotherapy after neoadjuvant chemoradiotherapy (CCRTx) followed by surgery in patients with esophageal squamous cell carcinoma (ESCC).
Materials and Methods
We retrospectively analyzed the data from 382 patients who received neoadjuvant CCRTx and esophagectomy for ESCC between 2003 and 2018.
Results
This study included 357 (93.4%) men, and the years median patient age was 63 (range, 40 to 84 years). Overall, 69 patients (18.1%) received adjuvant chemotherapy, whereas 313 patients (81.9%) did not. The median follow-up period was 28.07 months (interquartile range, 15.50 to 62.59). The 5-year overall survival (OS) and disease-free survival were 47.1% and 42.6%, respectively. Adjuvant chemotherapy did not improve OS in all patients, but subgroup analysis revealed that adjuvant chemotherapy improved the 5-year OS in patients with ypT+N+ (24.8% vs. 29.9%, p=0.048), whereas the survival benefit of adjuvant chemotherapy was not observed in patients with ypT0N0, ypT+N0, or ypT0N+. Multivariable analysis revealed that ypStage and adjuvant chemotherapy (hazard ratio, 0.601; p=0.046) were associated with OS in patients with ypT+N+. Freedom from distant metastasis was marginally different according to the adjuvant chemotherapy (48.3% vs. 41.3%, p=0.141).
Conclusion
Adjuvant chemotherapy after neoadjuvant therapy followed by surgery reduces the distant metastasis in ypT+N+ ESCC patients, thereby improving the OS. The consideration could be given to administration of adjuvant chemotherapy to ypT+N+ ESCC patients with tolerable conditions.

Citations

Citations to this article as recorded by

Postoperative Adjuvant Therapy Benefits Non‐pCR Patients Rather Than pCR Patients for Locally Advanced ESCC: A Multicenter Real‐World Study
Defeng Liu, Ao Liu, Longxiang Guo, Yi Li, Yuanlin Li, Yuxiang Chi, Haiqun Lin, Jinming Yu, Minghuan Li
Thoracic Cancer.2025;[Epub] CrossRef
Prognostic role of effective radiation dose to immune cells in esophageal cancer treated with definitive chemoradiation
Yoo Kyung Choi, Seok Hyun Son, Hong Seok Jang, In-Ho Kim, Sea-Won Lee, Soo-Yoon Sung, Satyajeet Rath
PLOS One.2025; 20(11): e0336794. CrossRef
Adjuvant therapy provides no additional recurrence-free benefit for esophageal squamous cell carcinoma patients after neoadjuvant chemoimmunotherapy and surgery: a multi-center propensity score match study
Shu-Han Xie, Li-Tao Yang, Hai Zhang, Zi-Lu Tang, Zhi-Wei Lin, Yi Chen, Zhi-Nuan Hong, Rong-Yu Xu, Wan-Li Lin, Ming-Qiang Kang
Frontiers in Immunology.2024;[Epub] CrossRef
Clinical implications of C-reactive protein–albumin–lymphocyte (CALLY) index in patients with esophageal cancer
Ruiya Ma, Yoshinaga Okugawa, Tadanobu Shimura, Shinji Yamashita, Yuhki Sato, Chengzeng Yin, Ryo Uratani, Takahito Kitajima, Hiroki Imaoka, Mikio Kawamura, Yuhki Morimoto, Yoshiki Okita, Shigeyuki Yoshiyama, Masaki Ohi, Yuji Toiyama
Surgical Oncology.2024; 53: 102044. CrossRef
Adjuvant immunotherapy after neoadjuvant immunochemotherapy and esophagectomy for esophageal squamous cell carcinoma: a real-world study
Jifeng Feng, Liang Wang, Xun Yang, Qixun Chen
Frontiers in Immunology.2024;[Epub] CrossRef

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Lung and Thoracic cancer

The Role of Adjuvant Therapy Following Surgical Resection of Small Cell Lung Cancer: A Multi-Center Study: Seong Yong Park, Samina Park, Geun Dong Lee, Hong Kwan Kim, Sehoon Choi, Hyeong Ryul Kim, Yong-Hee Kim, Dong Kwan Kim, Seung-Il Park, Tae Hee Hong, Yong Soo Choi, Jhingook Kim, Jong Ho Cho, Young Mog Shim, Jae Ill Zo, Kwon Joong Na, In Kyu Park, Chang Hyun Kang, Young-Tae Kim, Byung Jo Park, Chang Young Lee, Jin Gu Lee, Dae Joon Kim, Hyo Chae Paik; Cancer Res Treat. 2023;55(1):94-102. Published online June 9, 2022; DOI: https://doi.org/10.4143/crt.2022.290

Abstract PDF Supplementary Material PubReader ePub

Purpose
This multi-center, retrospective study was conducted to evaluate the long-term survival in patients who underwent surgical resection for small cell lung cancer (SCLC) and to identify the benefit of adjuvant therapy following surgery.
Materials and Methods
The data of 213 patients who underwent surgical resection for SCLC at four institutions were retrospectively reviewed. Patients who received neoadjuvant therapy or an incomplete resection were excluded.
Results
The mean patient age was 65.29±8.93 years, and 184 patients (86.4%) were male. Lobectomies and pneumonectomies were performed in 173 patients (81.2%), and 198 (93%) underwent systematic mediastinal lymph node dissections. Overall, 170 patients (79.8%) underwent adjuvant chemotherapy, 42 (19.7%) underwent radiotherapy to the mediastinum, and 23 (10.8%) underwent prophylactic cranial irradiation. The median follow-up period was 31.08 months (interquartile range, 13.79 to 64.52 months). The 5-year overall survival (OS) and disease-free survival were 53.4% and 46.9%, respectively. The 5-year OS significantly improved after adjuvant chemotherapy in all patients (57.4% vs. 40.3%, p=0.007), and the survival benefit of adjuvant chemotherapy was significant in patients with negative node pathology (70.8% vs. 39.7%, p=0.004). Adjuvant radiotherapy did not affect the 5-year OS (54.6% vs. 48.5%, p=0.458). Age (hazard ratio [HR], 1.032; p=0.017), node metastasis (HR, 2.190; p < 0.001), and adjuvant chemotherapy (HR, 0.558; p=0.019) were associated with OS.
Conclusion
Adjuvant chemotherapy after surgical resection in patients with SCLC improved the OS, though adjuvant radiotherapy to the mediastinum did not improve the survival or decrease the locoregional recurrence rate.

Citations

Citations to this article as recorded by

Application of postoperative adjuvant radiotherapy in limited-stage small cell lung cancer: A systematic review and meta-analysis
Chuanhao Zhang, Genghao Zhao, Huajian Wu, Jianing Jiang, Wenyue Duan, Zhijun Fan, Zhe Wang, Ruoyu Wang
Radiotherapy and Oncology.2024; 193: 110123. CrossRef
A 15-Gene-Based Risk Signature for Predicting Overall Survival in SCLC Patients Who Have Undergone Surgical Resection
Sevcan Atay
Cancers.2023; 15(21): 5219. CrossRef

7,920 View
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4 Web of Science
2 Crossref

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