Division of Thoracic Surgery, New York Presbyterian Hospital, Weill Cornell Medical College, New York, NY 10021, USA.
J Thorac Cardiovasc Surg. 2010 Feb;139(2):387-94. doi: 10.1016/j.jtcvs.2009.10.003. Epub 2009 Dec 16.
In patients with esophageal cancer, a complete pathologic response after preoperative therapy is universally regarded as a favorable prognostic factor. However, less is known about factors predictive of outcome in patients with persistent nodal disease. The purpose of this study is to determine which variables affect survival in this patient population.
We reviewed a prospectively maintained esophageal cancer database. Patients with positive lymph nodes after preoperative therapy and surgery were selected. Predictors of survival were examined univariately using the log-rank test. Factors identified at P < .20 by univariate analysis were selected for inclusion in a multivariate model.
Ninety-six patients with 1 or more positive nodes received preoperative therapy. Pathologic T classification was 0 to 2 in 25 (26%) patients and 3 to 4 in 71 (74%) patients. In 29 (30%) patients, nonregional nodal disease was present (M1). Final pathologic stages were IIB in 18 (19%), III in 49 (51%), and IV in 29 (30%). Postoperatively, 44 (46%) patients received additional chemotherapy. On univariate analysis, pathologic stage, pathologic T classification, and number of positive nodes significantly affected overall survival. On multivariate analysis, clinical stage (hazard ratio [HR], 2.25; P = .05), pathologic T classification (HR, 3.06; P = .006), and number of positive nodes (HR 1.03 per node, P = .09) were significant predictors of overall survival.
Long-term survival can be achieved in patients with esophageal cancer who have persistent nodal disease after neoadjuvant therapy and surgical resection. Clinical stage, pathologic T classification, and number of positive nodes best predict survival. Nonregional nodal disease does not adversely affect outcome. Postoperative chemotherapy conferred no additional survival benefit in this patient population.
在接受术前治疗的食管癌患者中，完全病理缓解被普遍认为是一种有利的预后因素。然而，对于持续性淋巴结疾病患者的预后预测因素知之甚少。本研究旨在确定哪些变量会影响这部分患者的生存。
我们回顾了一个前瞻性维护的食管癌数据库。选择术前治疗和手术后淋巴结阳性的患者。使用对数秩检验对生存的预测因素进行单因素分析。单因素分析中 P <.20 的因素被选择纳入多因素模型。
96 例患者有 1 个或多个阳性淋巴结，接受了术前治疗。病理 T 分类在 25 例（26%）患者中为 0 至 2 期，在 71 例（74%）患者中为 3 至 4 期。在 29 例（30%）患者中，存在非区域性淋巴结疾病（M1）。最终的病理分期为 IIB 期 18 例（19%），III 期 49 例（51%），IV 期 29 例（30%）。术后，44 例（46%）患者接受了辅助化疗。单因素分析显示，病理分期、病理 T 分类和阳性淋巴结数量均显著影响总生存。多因素分析显示，临床分期（危险比[HR]，2.25；P =.05）、病理 T 分类（HR，3.06；P =.006）和阳性淋巴结数量（每增加 1 个淋巴结 HR 为 1.03，P =.09）是总生存的显著预测因素。
接受新辅助治疗和手术切除后仍有淋巴结疾病的食管癌患者可获得长期生存。临床分期、病理 T 分类和阳性淋巴结数量可最佳预测生存。非区域性淋巴结疾病不会对预后产生不利影响。在这部分患者人群中，术后化疗并未带来额外的生存获益。
