在局部晚期食管癌新辅助放化疗后，囊外淋巴结受累是一个不良预后因素。

Extracapsular lymph node involvement is a negative prognostic factor after neoadjuvant chemoradiotherapy in locally advanced esophageal cancer.

作者信息

D'Journo Xavier Benoît, Avaro Jean Philippe, Michelet Pierre, Trousse Delphine, Tasei Anne Marie, Dahan Laetitia, Doddoli Christophe, Guidicelli Roger, Fuentes Pierre, Seitz Jean Francois, Thomas Pascal

机构信息

Department of Thoracic Surgery and Diseases of the Esophagus, Sainte Marguerite University Hospital, Marseille, France.

出版信息

J Thorac Oncol. 2009 Apr;4(4):534-9. doi: 10.1097/jto.0b013e31819c862d.

DOI:10.1097/jto.0b013e31819c862d

PMID:19347985

Abstract

INTRODUCTION

To assess prognosis depending on whether lymph node involvement (LNI) is intracapsular or with extracapsular breakthrough in patients with a locally advanced esophageal cancer treated with neoadjuvant chemoradiation and surgery.

METHODS

Ninety-four consecutive patients with an esophageal cancer staged IIB (n = 17) and III (n = 77) received neoadjuvant chemoradiation followed by transthoracic esophagectomy with two-field lymphadenectomy. Histology was squamous cell carcinoma (n = 46) and adenocarcinoma (n = 48). Neoadjuvant therapy consisted of association of 5-fluorouracil/cisplatin concomitantly with a 45-Gy radiation therapy. Disease-free survival (DFS) excluding the in-hospital mortality was analyzed according to the nodal status and the invaded/resected lymph node ratio (LNR). Clinical factors affecting survival or predictors of extracapsular invasion were investigated by multivariate analysis.

RESULTS

Five-year DFS rates were 46, 36, and 11% in N0 patients (n = 56), intracapsular LNI patients (n = 18), and extracapsular LNI patients (n = 10), respectively (p = 0.002). Intracapsular LNI patients with an LNR <0.1 (n = 12) had a 5-year DFS rate similar to N0 patients (44 versus 46%, p = 0.95). Intracapsular LNI patients with an LNR > or =0.1 (n = 6) had a DFS rate similar to extracapsular LNI patients (18 versus 11%, p = 0.69). Multivariate analysis revealed that the sole independent factor affecting DFS was the extracapsular LNI (HR = 3.9, p = 0.026). The number of invaded LN seemed to be the sole significant predictive factor for the development of ECLNI (HR = 2.39, p = 0.008).

CONCLUSION

After neoadjuvant chemoradiotherapy, there was a significant difference on DFS depending on whether LNI was intracapsular or extracapsular. Extracapsular invasion seems to be an independent negative prognostic factor affecting survival, and its presence is related to the number of invaded LN.

摘要

引言

评估新辅助放化疗联合手术治疗的局部晚期食管癌患者，根据淋巴结受累（LNI）是包膜内还是有包膜外侵犯的情况判断预后。

方法

94例连续的IIB期（n = 17）和III期（n = 77）食管癌患者接受新辅助放化疗，随后行经胸食管切除术及二野淋巴结清扫术。组织学类型为鳞状细胞癌（n = 46）和腺癌（n = 48）。新辅助治疗包括5-氟尿嘧啶/顺铂联合45 Gy放疗。根据淋巴结状态和受累/切除淋巴结比率（LNR）分析排除院内死亡后的无病生存期（DFS）。通过多因素分析研究影响生存的临床因素或包膜外侵犯的预测因素。

结果

N0患者（n = 56）、包膜内LNI患者（n = 18）和包膜外LNI患者（n = 10）的5年DFS率分别为46%、36%和11%（p = 0.002）。LNR<0.1的包膜内LNI患者（n = 12）的5年DFS率与N0患者相似（44%对46%，p = 0.95）。LNR≥0.1的包膜内LNI患者（n = 6）的DFS率与包膜外LNI患者相似（18%对11%，p = 0.69）。多因素分析显示，影响DFS的唯一独立因素是包膜外LNI（HR = 3.9，p = 0.026）。受累淋巴结数量似乎是包膜外LNI发生的唯一重要预测因素（HR = 2.39，p = 0.008）。