Division of Thoracic Surgery, New York-Presbyterian Hospital, Weill Cornell Medical College, New York 10021, USA.
Eur J Cardiothorac Surg. 2012 Oct;42(4):659-64. doi: 10.1093/ejcts/ezs105. Epub 2012 Apr 4.
The Worldwide Oesophageal Cancer Collaboration (WECC) reported recommendations regarding the optimum number of lymph nodes to be removed during oesophagectomy based upon patients undergoing surgery alone. We sought to determine whether these recommendations are relevant in the case of oesophageal cancer (EC) patients receiving neoadjuvant therapy.
Patients undergoing neoadjuvant chemotherapy followed by transthoracic en bloc oesophagectomy were reviewed. Patients were grouped by optimal versus suboptimal lymphadenectomy per WECC recommendations (pTis/T0/T1 ≥ 10; pT2 ≥ 20; pT3/T4 ≥ 30). Cohorts were compared for factors predicting optimal lymphadenectomy and for overall survival (OS).
During the time period, 135 patients (adeno = 100, squamous = 35) met the study criteria, of whom 94 patients (70%) had optimal lymphadenectomy. Optimal lymphadenectomy was more likely for tumours with lower ypT (P ≤ 0.001). Optimal lymphadenectomy predicted the OS (0.50, confidence intervals 0.29-0.85, P = 0.011), although it was collinear with ypT classification, which was also predictive. Patients not down-staged in ypT (n = 66, 49%) particularly experienced a trend towards improved 3-year survival with optimal lymphadenectomy (51 versus 29%, P = 0.144). Similarly, of patients with persistent nodal disease (n = 79, 59%), those who had optimal lymphadenectomy (n = 51) experienced improved 3-year OS compared with those with suboptimal lymphadenectomy (n = 28), (55 versus 36%, P = 0.087).
WECC recommendations regarding lymphadenectomy for EC may be applicable to patients undergoing oesophagectomy following neoadjuvant therapy, particularly those who are not down-staged by pathological tumour depth (T) classification and those with persistent nodal metastases. Techniques to enhance the extent of LAN should be pursued in this patient population.
世界食管癌协作组（WECC）根据仅接受手术治疗的患者报告了有关食管切除术时应切除的最佳淋巴结数量的建议。我们试图确定这些建议在接受新辅助治疗的食管癌（EC）患者中是否相关。
回顾性分析接受新辅助化疗后行经胸整块食管切除术的患者。根据 WECC 建议（Tis/T0/T1 期≥10；T2 期≥20；T3/T4 期≥30）将患者分为最佳淋巴结切除术组和次优淋巴结切除术组。比较两组预测最佳淋巴结切除术的因素和总生存（OS）。
在此期间，符合研究标准的 135 例患者（腺癌 100 例，鳞癌 35 例）中，94 例（70%）行最佳淋巴结切除术。肿瘤 ypT 越低，行最佳淋巴结切除术的可能性越大（P≤0.001）。尽管与 ypT 分类存在共线性，且后者也具有预测价值，但最佳淋巴结切除术预测 OS（0.50，置信区间 0.29-0.85，P=0.011）。ypT 分期未降级的患者（n=66，49%）尤其表现出最佳淋巴结切除术与改善 3 年生存率的趋势（51%与 29%，P=0.144）。同样，对于淋巴结持续存在疾病的患者（n=79，59%），行最佳淋巴结切除术（n=51）的患者 3 年 OS 优于行次优淋巴结切除术（n=28）的患者（55%与 36%，P=0.087）。
WECC 关于 EC 淋巴结切除术的建议可能适用于接受新辅助治疗后行食管切除术的患者，特别是那些未因病理肿瘤深度（T）分类降级和那些淋巴结持续转移的患者。应在这一患者人群中探索增强淋巴结清扫范围的技术。
