Hofstetter Wayne, Correa Arlene M, Bekele Neby, Ajani Jaffer A, Phan Alexandria, Komaki Ritsuko R, Liao Zhongxing, Maru Dipen, Wu Tsung T, Mehran Reza J, Rice David C, Roth Jack A, Vaporciyan Ara A, Walsh Garrett L, Francis Ashleigh, Blackmon Shanda, Swisher Stephen G
Department of Thoracic and Cardiovascular Surgery, University of Texas MD Anderson Cancer Center, Houston, Texas 77030, USA.
Ann Thorac Surg. 2007 Aug;84(2):365-73; discussion 374-5. doi: 10.1016/j.athoracsur.2007.01.067.
The current American Joint Committee on Cancer (AJCC) esophageal cancer staging for nodal status is difficult to interpret and is based solely on lymph node location relative to the primary tumor's esophageal location. Recent reports suggest that the number of lymph nodes involved is also an important factor. We reviewed our esophageal experience to propose an improved nodal staging system.
In all, 1,027 patients with resected esophageal cancer from 1970 to 2005 were reviewed. Lymph nodes stations were assigned according to AJCC criteria. Overall survival was assessed by Kaplan-Meier analysis. The impact of location, number of involved lymph nodes, and use of preoperative chemotherapy or radiation therapy, or both, was assessed.
Nonregional nodal involvement (n = 17) was associated with decreased survival compared with regional (n = 441) or celiac nodal (n = 73) involvement (3-year: 0% versus 24% and 23%; p < 0.001). The number of involved lymph nodes was strongly associated with survival (3-year: 0 nodes = 63%, 1 to 3 nodes = 31%, more than 3 nodes = 13%; p < 0.001), and multivariable Cox proportional-hazards analysis suggested that the location and number of involved lymph nodes were independent predictors of survival (p < 0.001). We propose a modified nodal staging system that designates celiac nodes as regional and includes number of involved nodes: pN0, no nodes (3 years = 63%, n = 496); pN1-regional, 1 to 3 nodes (3 years = 32%, n = 292); pN2-regional, more than 3 nodes (3 years = 14%, n = 222); pN3-nonregional node (3 years = 0%, n = 17 [p < 0.0001]). This modified nodal staging system better predicts survival than the current AJCC nodal staging system in which survival for pN1 (3 years = 24%) and pM1a (3 years = 23%) do not differ (p = 0.67). The use of induction before surgical resection did not alter the predictive effect of the new nodal staging system.
Modification of the AJCC nodal classification system to incorporate the number of involved lymph nodes with regional and nonregional node location simplifies and better predicts long-term survival than does the current AJCC nodal system.
当前美国癌症联合委员会（AJCC）对食管癌淋巴结状态的分期难以解读，且仅基于淋巴结相对于原发肿瘤食管位置的定位。近期报告表明，受累淋巴结的数量也是一个重要因素。我们回顾了我们在食管癌方面的经验，以提出一种改进的淋巴结分期系统。
总共回顾了1970年至2005年期间1027例接受食管癌切除术的患者。根据AJCC标准对淋巴结站进行分类。通过Kaplan-Meier分析评估总生存期。评估了位置、受累淋巴结数量以及术前化疗或放疗或两者兼用的影响。
与区域淋巴结受累（n = 441）或腹腔淋巴结受累（n = 73）相比，非区域淋巴结受累（n = 17）与生存期降低相关（3年生存率：0% 对 24% 和 23%；p < 0.001）。受累淋巴结数量与生存期密切相关（3年生存率：0个淋巴结 = 63%，1至3个淋巴结 = 31%，超过3个淋巴结 = 13%；p < 0.001），多变量Cox比例风险分析表明，受累淋巴结的位置和数量是生存期的独立预测因素（p < 0.001）。我们提出一种改良的淋巴结分期系统，将腹腔淋巴结指定为区域淋巴结，并纳入受累淋巴结数量：pN0，无淋巴结（3年生存率 = 63%，n = 496）；pN1-区域，1至3个淋巴结（3年生存率 = 32%，n = 292）；pN2-区域，超过3个淋巴结（3年生存率 = 14%，n = 222）；pN3-非区域淋巴结（3年生存率 = 0%，n = 17 [p < 0.0001]）。这种改良的淋巴结分期系统比当前的AJCC淋巴结分期系统能更好地预测生存期，在当前AJCC分期系统中，pN1（3年生存率 = 24%）和pM1a（3年生存率 = 23%）的生存率无差异（p = 0.67）。手术切除前进行诱导治疗并未改变新的淋巴结分期系统的预测效果。
对AJCC淋巴结分类系统进行改良，将受累淋巴结数量与区域和非区域淋巴结位置相结合，比当前的AJCC淋巴结系统更简单且能更好地预测长期生存期。
