Department of Surgery, Kurume University School of Medicine, Fukuoka, Japan.
Ann Surg Oncol. 2012 Mar;19(3):750-6. doi: 10.1245/s10434-011-2023-6. Epub 2011 Aug 23.
There are controversies regarding the extent of lymphadenectomy necessary during the course of esophagectomy for submucosal esophageal cancer. The purpose of this study was to examine the long-term outcomes after esophagectomy with extended lymphadenectomy in patients with submucosal esophageal cancer and to investigate the prognostic factors in these patients.
A prospectively maintained database identified 105 previously untreated patients with submucosal esophageal cancer who underwent transthoracic esophagectomy with three-field or two-field lymphadenectomy. Median follow-up was 101 months.
All patients received R0 resection. Ninety-eight patients had squamous cell carcinoma, and seven had adenocarcinoma. Lymph node metastasis was present in 38 patients (36.2%), of whom 9 patients (23.7%) had positive cervical nodes. Thirty-five patients (33.3%) had other primary malignancies. The overall 5- and 10-year survival rates were 74.4 and 57.4%, respectively. The cause of death was recurrent disease in 16 patients, other malignancy in 12, and noncancer-related disease in 18. Univariate analyses demonstrated that other primary malignancy (P = 0.0041), poor differentiation (P = 0.0203), and angiolymphatic invasion (P = 0.0347) significantly affected overall survival. There was no difference in survival between patients with lymph node metastasis and those without (P = 0.9809). Multivariate analysis found other primary malignancy to be the only independent prognostic factor (hazards ratio, 2.295; 95% confidence interval, 1.201-4.386; P = 0.0119).
Esophagectomy with extended lymphadenectomy for submucosal esophageal cancer results in 57.4% survival at 10 years. Other primary malignancy is the only independent predictor affecting long-term survival. Patients should be examined rigorously for other primary malignancy as well as recurrent disease during long-term follow-up.
在黏膜下食管癌的食管切除术中，淋巴结清扫的范围存在争议。本研究旨在探讨黏膜下食管癌患者行扩大淋巴结清扫术的长期结果，并分析这些患者的预后因素。
前瞻性维护的数据库确定了 105 例先前未经治疗的黏膜下食管癌患者，这些患者接受了经胸食管切除术，并进行了三野或两野淋巴结清扫。中位随访时间为 101 个月。
所有患者均行 R0 切除。98 例为鳞状细胞癌，7 例为腺癌。38 例（36.2%）患者存在淋巴结转移，其中 9 例（23.7%）患者有颈部淋巴结阳性。35 例（33.3%）患者有其他原发性恶性肿瘤。总的 5 年和 10 年生存率分别为 74.4%和 57.4%。16 例患者死于复发性疾病，12 例死于其他恶性肿瘤，18 例死于非癌症相关疾病。单因素分析显示，其他原发性恶性肿瘤（P=0.0041）、低分化（P=0.0203）和血管淋巴管侵犯（P=0.0347）显著影响总生存率。有淋巴结转移和无淋巴结转移的患者的生存率无差异（P=0.9809）。多因素分析发现，其他原发性恶性肿瘤是唯一的独立预后因素（风险比，2.295；95%置信区间，1.201-4.386；P=0.0119）。
黏膜下食管癌行扩大淋巴结清扫术的 10 年生存率为 57.4%。其他原发性恶性肿瘤是影响长期生存的唯一独立预测因素。在长期随访中，患者应严格检查其他原发性恶性肿瘤和复发性疾病。
