Gu Yan, Swisher Stephen G, Ajani Jaffer A, Correa Arlene M, Hofstetter Wayne L, Liao Zhongxing, Komaki Ritsuko R, Rashid Asif, Hamilton Stanley R, Wu Tsung-Teh
Department of Pathology, The University of Texas M. D. Anderson Cancer Center, Houston, Texas 77030, USA.
Cancer. 2006 Mar 1;106(5):1017-25. doi: 10.1002/cncr.21693.
The survival of patients with locoregional adenocarcinoma of the esophagus or the esophagogastric junction (EGJ) who receive preoperative chemoradiation is reported to be better among patients who achieve a pathologic complete response than among patients who have residual tumor, including lymph node (LN) metastasis. However, the prognostic significance of the number of LNs with residual metastasis remains unclear.
The authors studied 187 consecutive patients who received chemoradiation followed by an esophagectomy. The number of positive LNs and the size of metastatic tumor in each positive LN were examined with regard to overall survival (OS) and recurrence-free survival (RFS).
A pathologic complete response was achieved by 29% of patients. No LN metastasis (posttherapy pathologic negative LN status [ypN0]) was present in 49% of patients who had residual carcinoma, and LN metastasis (ypN1) was present in 51% of patients. The 5-year OS and 2-year RFS rates achieved by patients who had 1 positive LN (34% and 45%, respectively) were similar to the rates achieved by patients in the ypN0 group (38% [P = 0.84] and 50% [P = 0.77], respectively) but were significantly better than the rates achieved by patients who had > or = 2 positive LNs (6% [P = 0.02] and 18% [P = 0.01], respectively). The size of metastatic tumor in LNs among patients who had 1 positive LN was a prognostic factor (> or = 4 mm vs. < 4 mm; P = 0.04). In multivariate analysis, OS was better in patients who had 1 LN metastasis among patients in the ypN1 group (P = 0.02) independent of their posttherapy pathologic tumor status.
The current results suggested that the number of LNs with metastasis is an independent prognostic factor in patients with residual adenocarcinoma of the esophagus or the EGJ after preoperative chemoradiation. The authors suggest modification of the tumor-lymph node-metastasis (TNM) staging classification (ypTNM) to include the number of positive LNs in the ypN1 category.
据报道，接受术前放化疗的食管或食管胃交界部（EGJ）局部区域腺癌患者中，达到病理完全缓解的患者生存率高于有残余肿瘤（包括淋巴结转移）的患者。然而，有残余转移的淋巴结数量的预后意义仍不明确。
作者研究了187例连续接受放化疗后行食管切除术的患者。就总生存期（OS）和无复发生存期（RFS）而言，检查了阳性淋巴结的数量以及每个阳性淋巴结中转移瘤的大小。
29%的患者实现了病理完全缓解。有残余癌的患者中，49%无淋巴结转移（治疗后病理阴性淋巴结状态[ypN0]），51%有淋巴结转移（ypN1）。有1个阳性淋巴结的患者的5年总生存率和2年无复发生存率（分别为34%和45%）与ypN0组患者的生存率（分别为38%[P = 0.84]和50%[P = 0.77]）相似，但显著优于有2个或更多阳性淋巴结的患者的生存率（分别为6%[P = 0.02]和18%[P = 0.01]）。有1个阳性淋巴结的患者中，淋巴结内转移瘤的大小是一个预后因素（≥4 mm与<4 mm；P = 0.04）。在多变量分析中，ypN1组中有1个淋巴结转移的患者总生存期更好（P = 0.02）,与治疗后病理肿瘤状态无关。
目前的结果表明，有转移的淋巴结数量是术前放化疗后食管或EGJ残余腺癌患者的独立预后因素。作者建议修改肿瘤-淋巴结-转移（TNM）分期分类（ypTNM），在ypN1类别中纳入阳性淋巴结的数量。
