FENG Jian, MAO Teng, CHEN Wen-hu, FANG Wen-tao
Center of Esophageal Cancer, Shanghai Chest Hospital, Shanghai 200030, China.
Zhonghua Wei Chang Wai Ke Za Zhi. 2011 Sep;14(9):715-8.
To evaluate the influence of the number, station and field of metastatic lymph node on the prognosis of thoracic esophageal cancer and to investigate an ideal nodal staging method.
Clinicopathological and follow-up data of the 204 patients who underwent thoracic esophagectomy from June 2001 to December 2009 were analyzed retrospectively and all the patients were re-staged according to the 7th edition of the AJCC TNM staging system. Log-rank test was applied to perform survival analysis according to lymph node metastasis staging(number, station, and field), Cox proportional hazard model was used to screen risk factors.
The follow-up rate was 93.1%(190/204). The median follow up time was 37.0(0-104) months. The overall and cancer-specific 5-year survival rates were 35.0% and 38.8%. When grouped according to the number of metastatic lymph node(0, 1-2, 3-6, ≥ 7), the 5-year survival rates of pN0, pN1, pN2 and pN3 were 47.8, 31.8%, 11.5% and 0 respectively(P=0.000). When grouped according to the number of stations of metastatic lymph node[N(0s), N(1s)(1 station LN metastasis), N(≥ 2s)(≥ 2 stations LN metastasis)], the 5-year survival rates of N(0s), N(1s), N(≥ 2s) were 47.8%, 31.5% and 11.3% respectively(P=0.000). When grouped according to the number of fields of metastatic lymph node, the 5-year survival rates of N0, 1 field, 2 fields and 3 fields involvement were 47.8%, 34.2%, 12.1% and 0 respectively(P=0.000). Cox regression showed that the number of stations [P=0.043, RR(95% CI)=1.540(1.013-2.342)], and the number of fields[P=0.010, RR(95%CI)=2.187(1.210-3.951)] of metastatic lymph node were the independent risk factors for survival.
The extent of metastatic lymph node is an independent risk factor for the prognosis of esophageal cancer patients. Revision of the current N-classification of TNM staging system according to the number of stations of metastatic lymph node may be more reasonable.
评估转移性淋巴结的数量、部位及区域对胸段食管癌预后的影响，并探寻理想的淋巴结分期方法。
回顾性分析2001年6月至2009年12月行胸段食管癌切除术的204例患者的临床病理及随访资料，所有患者均依据美国癌症联合委员会（AJCC）第7版TNM分期系统重新分期。采用对数秩检验根据淋巴结转移分期（数量、部位及区域）进行生存分析，运用Cox比例风险模型筛选危险因素。
随访率为93.1%（190/204）。中位随访时间为37.0（0 - 104）个月。总生存率和癌症特异性5年生存率分别为35.0%和38.8%。根据转移性淋巴结数量分组（0、1 - 2、3 - 6、≥7），pN0、pN1、pN2和pN3的5年生存率分别为47.8%、31.8%、11.5%和0（P = 0.000）。根据转移性淋巴结部位数量分组[N(0s)、N(1s)（1个部位淋巴结转移）、N(≥2s)（≥2个部位淋巴结转移）]，N(0s)、N(1s)、N(≥2s)的5年生存率分别为47.8%、31.5%和11.3%（P = 0.000）。根据转移性淋巴结区域数量分组，N0、1个区域、2个区域和3个区域受累的5年生存率分别为47.8%、34.2%、12.1%和0（P = 0.000）。Cox回归显示，转移性淋巴结的部位数量[P = 0.043，RR(95%CI)=1.540(1.013 - 2.342)]和区域数量[P = 0.010，RR(95%CI)=2.187(1.210 - 3.951)]是生存的独立危险因素。
转移性淋巴结的范围是食管癌患者预后的独立危险因素。根据转移性淋巴结的部位数量对现行TNM分期系统的N分类进行修订可能更为合理。
