Tanabe Tadashi, Kanda Tatsuo, Kosugi Shin-Ichi, Ikeda Yoshiyuki, Makino Shigeto, Komukai Shintaro, Ohashi Manabu, Suzuki Tsutomu, Hatakeyama Katsuyoshi
Division of Digestive and General Surgery, Niigata University Graduate School of Medical and Dental Sciences, Asahimachi-dori 1-757, Niigata City 951-8510, Japan.
World J Surg. 2007 Nov;31(11):2192-8. doi: 10.1007/s00268-007-9204-2. Epub 2007 Sep 17.
Microscopic cancer spreading to extranodal connective tissues (extranodal spreading: ENS) is occasionally found in resected specimens from patients with esophageal squamous cell carcinoma (SCC), but the prognostic impact of ENS remains unclear. The aims of this study were to elucidate the prognostic impact of ENS to help determine the most suitable management for the patients with ENS.
We histologically re-evaluated 7,349 lymph nodes obtained from 171 patients with SCC of the thoracic esophagus who underwent potentially curable resection between 1992 and 2003. We defined ENS as microscopic penetration of tumor cells from metastatic lymph nodes or tumor cell dissemination into extranodal connective tissues.
Extranodal spreading was found in 37 (21.6%) patients, and it had a significant relationship with diameter and depth of the tumor, lymphatic and venous invasion, intramural metastasis, and number of metastatic nodes. Patients who were ENS positive were at higher risk of recurrence, and their overall survival rate was lower than that for ENS-negative patients. Furthermore, recurrent risk was higher and overall survival rate was lower in ENS-positive patients than in ENS-negative patients when they had 1-3 metastatic nodes, but recurrent risk and overall survival rate of the patients with 4 or more metastatic nodes were very similar in ENS-positive and ENS-negative patients.
The present findings suggest that in SCC of the thoracic esophagus, the presence of ENS increases recurrent risk and reduces the overall survival of the patients with 1-3 metastatic nodes. Patients showing ENS should be managed in the same way as patients with 4 or more metastatic nodes.
在食管鳞状细胞癌（SCC）患者的切除标本中偶尔会发现癌细胞向结外结缔组织的微小扩散（结外扩散：ENS），但ENS对预后的影响仍不清楚。本研究的目的是阐明ENS对预后的影响，以帮助确定对ENS患者最合适的治疗方案。
我们对1992年至2003年间接受了可能治愈性切除的171例胸段食管SCC患者的7349个淋巴结进行了组织学重新评估。我们将ENS定义为肿瘤细胞从转移性淋巴结的微小浸润或肿瘤细胞扩散至结外结缔组织。
37例（21.6%）患者发现有结外扩散，且与肿瘤直径、深度、淋巴管和静脉侵犯、壁内转移以及转移淋巴结数量有显著关系。ENS阳性患者复发风险更高，其总生存率低于ENS阴性患者。此外，当ENS阳性患者有1 - 3个转移淋巴结时，其复发风险高于ENS阴性患者，总生存率低于ENS阴性患者，但当有4个或更多转移淋巴结时，ENS阳性和ENS阴性患者的复发风险和总生存率非常相似。
目前的研究结果表明，在胸段食管SCC中，ENS的存在增加了有1 - 3个转移淋巴结患者的复发风险并降低了其总生存率。显示有ENS的患者应与有4个或更多转移淋巴结的患者接受相同的治疗。
