Department of Thoracic Surgery, Provincial Hospital Affiliated to Shandong University, Jinan, 250021, Shandong, People's Republic of China.
World J Surg. 2011 Jan;35(1):70-7. doi: 10.1007/s00268-010-0829-1.
The purpose of the present study was to investigate the risk factors associated with lymph node metastatic recurrence in patients with N0 esophageal cancer after Ivor-Lewis esophagectomy based on the detection of Mucin 1 mRNA and vascular endothelial growth factor (VEGF) C mRNA.
The subjects were 82 patients with pN0 esophageal cancer who underwent Ivor-Lewis esophagectomy with two-field lymph node dissection from January 2001 to January 2005. A total of 501 lymph nodes obtained from these patients were re-evaluated by reverse transcriptase-polymerase chain reaction (RT-PCR) to detect mucin l (MUC1) mRNA; VEGF-C mRNA was also detected in esophageal cancer issues by RT-PCR. The diagnosis of lymph node micrometastasis (LNMM) was based on the detection of MUC1 mRNA. The Kaplan-Meier method was used to calculate the survival rate and lymph nodal metastatic rate, the log-rank test was performed to compare the recurrence rate, and Cox regression multivariate analysis was performed to determine independent prognostic factors.
MUC1 mRNA was detected in 29 lymph nodes from 23 patients, which accounted for 5.79% of all the 501 lymph nodes and 28.05% of all 82 patients, respectively. Vascular endothelial growth factor C mRNA was identified in esophageal cancer issues from 42 (51.22%) patients. The overall 3- and 5-year survival rates of 82 patients were 78.0 and 51.2%, respectively. First recurrence exhibiting lymph nodal metastasis was recognized in 37 patients (45.1%) in the first 3 years after operation. The lymph node metastatic rate in patients in the first 3 years after operation was significantly associated with T status (p < 0.05) and the lymph node metastatic rate of the patients with LNMM was significantly higher than that of the patients without LNMM (p < 0.01). The lymph node metastatic rate of the patients with VEGF-C mRNA expression in esophageal cancer tissues was significantly higher than that of the patients without VEGF-C mRNA expression (p < 0.01).The results of multivariate analysis confirmed that VEGF-C mRNA expression in esophageal cancer tissues, LNMM, and T status in patients with N0 esophageal cancer were independent relevant factors for 3-year lymph node metastatic recurrence after Ivor-Lewis esophagectomy.
Vascular endothelial growth factor C mRNA expression in esophageal cancer tissues, LNMM, and T status in patients with N0 esophageal cancer were independent risk factors for 3-year lymph node metastatic recurrence after Ivor-Lewis esophagectomy. Adjunctive therapy might be beneficial in controlling the locoregional recurrence and elevated healing rates for certain patients.
本研究旨在通过检测黏蛋白 1（Mucin 1）mRNA 和血管内皮生长因子 C（VEGF-C）mRNA，探讨 Ivor-Lewis 食管切除术治疗 N0 期食管癌患者发生淋巴结转移复发的相关危险因素。
2001 年 1 月至 2005 年 1 月，82 例接受 Ivor-Lewis 食管切除术和两野淋巴结清扫术的 pN0 期食管癌患者纳入本研究。采用逆转录-聚合酶链反应（RT-PCR）对这些患者的 501 枚淋巴结进行重新评估，以检测黏蛋白 1（MUC1）mRNA；采用 RT-PCR 检测食管癌组织中的 VEGF-CmRNA。根据 MUC1mRNA 的检测结果诊断淋巴结微转移（LNMM）。采用 Kaplan-Meier 法计算生存率和淋巴结转移率，采用对数秩检验比较复发率，采用 Cox 回归多因素分析确定独立预后因素。
23 例患者的 29 枚淋巴结中检测到 MUC1mRNA，占所有 501 枚淋巴结的 5.79%和所有 82 例患者的 28.05%。42 例（51.22%）患者的食管癌组织中检测到 VEGF-CmRNA。82 例患者的 3 年和 5 年总生存率分别为 78.0%和 51.2%。术后 3 年内首次复发并出现淋巴结转移的患者有 37 例（45.1%）。术后 3 年内淋巴结转移率与 T 分期显著相关（p<0.05），且 LNMM 患者的淋巴结转移率明显高于无 LNMM 患者（p<0.01）。食管癌组织中 VEGF-CmRNA 表达阳性患者的淋巴结转移率明显高于 VEGF-CmRNA 表达阴性患者（p<0.01）。多因素分析结果证实，N0 期食管癌患者的食管癌组织中 VEGF-CmRNA 表达、LNMM 和 T 分期是 Ivor-Lewis 食管切除术后 3 年淋巴结转移复发的独立相关因素。
食管癌组织中 VEGF-CmRNA 表达、LNMM 和 N0 期食管癌患者的 T 分期是 Ivor-Lewis 食管切除术后 3 年淋巴结转移复发的独立危险因素。辅助治疗可能有助于控制局部区域复发，提高某些患者的愈合率。
