Department of Radiation Oncology, Moffitt Cancer Center, Tampa, FL, USA.
Ann Surg Oncol. 2013 Sep;20(9):3038-43. doi: 10.1245/s10434-013-2988-4. Epub 2013 Apr 28.
This study was designed to determine the effects of lymph node (LN) harvest on survival in esophageal cancer after neoadjuvant chemoradiation (nCRT).
An analysis of surgically resected esophageal cancer patients after nCRT was performed to determine an association between the number of LNs resected and survival. Overall survival (OS) and disease-free survival (DFS) curves were calculated according to the Kaplan-Meier method and log-rank analysis. Multivariate analysis (MVA) was performed by the Cox proportional hazard model.
We identified 358 patients with a mean follow-up of 27.3 months. The number of LN removed was not impacted by the type of surgical procedure. The number of LNs removed (<10 vs. ≥10, <12 vs. ≥12, and <15 vs. ≥15) did not impact OS or DFS. We found a significant difference in OS and DFS by pathologic response. The median and 5-year OS for patients with complete, partial, and no response was 65.6 months and 52.7%, 29.7 months and 30.4%, and 17.7 months and 25.4% (p=0.0002). However, the number of LN harvested did not impact OS and DFS when patients were stratified by pathologic response. MVA also revealed that the number of lymph nodes removed was not prognostic for OS or DFS. Higher age, higher stage, and less than a complete response were associated with a decreased OS. Higher stage and less than a complete response were prognostic for worse DFS.
The number of LNs harvested during esophagectomy does not impact survival after nCRT. Stage and pathologic response continue to be the strongest prognostic factors for survival in esophageal cancer after nCRT.
本研究旨在确定新辅助放化疗（nCRT）后食管癌淋巴结清扫对生存的影响。
对接受 nCRT 后手术切除的食管癌患者进行分析，以确定切除淋巴结数量与生存之间的关系。根据 Kaplan-Meier 方法和对数秩分析计算总生存期（OS）和无病生存期（DFS）曲线。采用Cox 比例风险模型进行多变量分析（MVA）。
我们共纳入 358 例患者，平均随访 27.3 个月。淋巴结清扫的数量不受手术方式的影响。切除的淋巴结数量（<10 与≥10、<12 与≥12、<15 与≥15）并不影响 OS 或 DFS。我们发现病理反应对 OS 和 DFS 有显著影响。完全、部分和无反应患者的中位 OS 和 5 年 OS 分别为 65.6 个月和 52.7%、29.7 个月和 30.4%、17.7 个月和 25.4%（p=0.0002）。然而，当根据病理反应对患者进行分层时，淋巴结清扫数量并不影响 OS 和 DFS。MVA 还显示，淋巴结清扫数量对 OS 和 DFS 无预后意义。较高的年龄、较高的分期和不完全反应与 OS 降低相关。较高的分期和不完全反应与较差的 DFS 相关。
nCRT 后食管癌淋巴结清扫数量不影响生存。分期和病理反应仍然是 nCRT 后食管癌生存的最强预后因素。
