Division of Thoracic and Cardiovascular Surgery, Chang Gung Memorial Hospital, Keelung, College of Medicine, Chang Gung University, Taoyuan, Taiwan.
J Surg Oncol. 2012 Sep 15;106(4):436-40. doi: 10.1002/jso.23103. Epub 2012 May 4.
Higher extent of lymph node dissection (LND) is beneficial in primarily resected esophageal cancer patients by providing accurate staging and better tumor control. Achieving pathological complete response (pCR) after chemoradiotherapy (CRT) also represents better outcome. We studied the controversial question whether higher LND could further improve survival after pCR.
Between 1996 and 2007, Esophageal squamous cell carcinoma (ESCC) patients with pCR after CRT were included. Based on the median number of dissected lymph node, patients were divided into two groups (Group 1: Lower LND; Group 2: Higher LND). We compared the demographic features, perioperative outcomes, recurrence, and survival between groups.
The cohort comprised 101 patients (100 males and one female) with a mean age of 58 years. There were 56 and 45 patients in Group 1 and 2, respectively. Clinical features and perioperative outcome were similar between groups. During a mean follow-up of 78.8 months, 32 (33.7%) patients died of the disease and 35.8% of patients developed recurrence. There was no difference in locoregional (11.3% vs. 9.5%, P=0.78) or distant recurrence (22.6% vs. 33.3%, P=0.18) between the two groups. Patients with lowest LND also had similar outcomes as those with the highest LND. The 5-year disease specific survival rate was 65 and 64% in Group 1 and 2, respectively.
In ESCC patients, the number of negative lymph nodes had no prognostic impact after pCR.
在接受根治性手术的食管癌患者中，扩大淋巴结清扫（LND）范围可提供更准确的分期和更好的肿瘤控制，从而获益。接受放化疗（CRT）后达到病理完全缓解（pCR）也代表着更好的预后。我们研究了一个有争议的问题，即 pCR 后更高程度的 LND 是否可以进一步改善生存。
1996 年至 2007 年间，纳入 CRT 后获得 pCR 的食管鳞状细胞癌（ESCC）患者。根据淋巴结清扫的中位数，患者被分为两组（组 1：淋巴结清扫较少；组 2：淋巴结清扫较多）。我们比较了两组患者的人口统计学特征、围手术期结局、复发和生存情况。
该队列包括 101 例患者（100 例男性和 1 例女性），平均年龄为 58 岁。组 1 和组 2 分别有 56 例和 45 例患者。两组患者的临床特征和围手术期结局相似。中位随访 78.8 个月期间，32 例（33.7%）患者死于疾病，35.8%的患者发生复发。两组患者的局部区域复发率（11.3%比 9.5%，P=0.78）或远处复发率（22.6%比 33.3%，P=0.18）无差异。LND 最少的患者与 LND 最多的患者的结局相似。组 1 和组 2 的 5 年疾病特异性生存率分别为 65%和 64%。
在 ESCC 患者中，pCR 后阴性淋巴结的数量对预后没有影响。
