Yano M, Takachi K, Doki Y, Miyashiro I, Kishi K, Noura S, Eguchi H, Yamada T, Ohue M, Ohigashi H, Sasaki Y, Ishikawa O, Matsunaga T, Imaoka S
Department of Surgery, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka, Japan.
Dis Esophagus. 2006;19(2):73-7. doi: 10.1111/j.1442-2050.2006.00543.x.
Patients with esophageal cancer often display relapse at cervical nodes after surgery, but their prognosis and a suitable therapy remains unknown. We retrospectively reviewed the records for 35 patients who underwent esophagectomy with lymphadenectomy who then displayed relapse at the cervical lymph nodes alone between 1985 and 2003 in order to observe the prognostic factors for such patients. Median survival time from the date of recurrence for all 35 patients was 12 months with 1-year, 2-year, 3-year and 5-year survival rate of 47.2%, 26.5%, 17.7% and 8.8%, respectively. With regard to the initial treatment against cervical node recurrence, 15 patients were treated by radiotherapy alone, eight by chemoradiotherapy, 11 by surgery and one by chemotherapy alone. Univariate analysis revealed that cervical node dissection at the prior esophagectomy (yes/no, P = 0.0178), time to recurrence (> 9 months or < 9 months, P = 0.0497) and the number of relapsed nodes (solitary/multiple, P = 0.0029) were significant prognostic factors. Among these factors, the number of relapsed nodes (solitary/multiple) was found to be the only significant prognostic factor with an odds ratio of 2.409 and 95% confidence interval of 1.033-5.619 by multivariate analysis. In conclusion, cervical node metastasis is generally considered to be distant organ metastasis. However, if it is a solitary node recurrence, substantial survival can be attained by appropriate loco-regional therapy.
食管癌患者术后常出现颈部淋巴结复发，但其预后及合适的治疗方法仍不明确。我们回顾性分析了1985年至2003年间35例行食管癌切除术加淋巴结清扫术且仅出现颈部淋巴结复发患者的病历，以观察此类患者的预后因素。35例患者自复发之日起的中位生存时间为12个月，1年、2年、3年和5年生存率分别为47.2%、26.5%、17.7%和8.8%。对于颈部淋巴结复发的初始治疗，15例患者仅接受放疗，8例接受放化疗，11例接受手术，1例仅接受化疗。单因素分析显示，先前食管癌切除术中颈部淋巴结清扫情况（是/否，P = 0.0178）、复发时间（> 9个月或< 9个月，P = 0.0497）以及复发淋巴结数量（单个/多个，P = 0.0029）是显著的预后因素。在这些因素中，多因素分析发现复发淋巴结数量（单个/多个）是唯一显著的预后因素，比值比为2.409，95%置信区间为1.033 - 5.619。总之，颈部淋巴结转移一般被认为是远处器官转移。然而，如果是单个淋巴结复发，通过适当的局部区域治疗可获得可观生存期。
