Zhang Peng, Xi Mian, Zhao Lei, Li Qiao-Qiao, He Liru, Liu Shiliang, Shen Jingxian, Liu Meng-Zhong
Sun Yat-sen University Cancer Center; State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine; Department of Radiation Oncology, Cancer Center, Sun Yat-sen University, Guangzhou, People's Republic of China.
Sun Yat-sen University Cancer Center; State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine; Imaging Diagnosis and Interventional Center, Cancer Center, Sun Yat-sen University, Guangzhou, People's Republic of China.
PLoS One. 2014 Jun 30;9(6):e101332. doi: 10.1371/journal.pone.0101332. eCollection 2014.
To determine the prognostic significance of unilateral cervical lymph nodal metastasis (CLNM) in patients with inoperable thoracic esophageal squamous cell carcinoma (SCC) and to identify significant prognostic factors in these patients.
This retrospective study involved 395 patients with inoperable esophageal SCC treated with concurrent chemoradiotherapy. The patients were classified into three groups according to their cervical lymph node status: group A, no evidence of CLNM; group B, unilateral CLNM; group C, other distant metastases. Overall survival (OS) and progression-free survival (PFS) were calculated. Significant prognostic factors were identified using univariate and multivariate analyses.
The 3-year OS rates in groups A, B and C were 46.7%, 33.5% and 8.3%, respectively (p<0.001, log-rank test). The corresponding PFS rates were 40.7%, 26.4% and 4.7% (p<0.001, log-rank test). Group B had a similar prognosis to that of group A and better 3-year OS (p = 0.009) and PFS (p = 0.006) rates than those of group C. Multivariate analysis demonstrated that T stage, chemotherapy regimen and cervical lymph node involvement were independent prognostic factors affecting OS and PFS.
Compared to other distant metastases, unilateral CLNM is associated with longer OS in esophageal SCC and should be regarded as a regional disease. Sex, T stage, concurrent chemotherapy modality and cervical lymph node involvement are independent predictors of survival in esophageal SCC.
确定单侧颈部淋巴结转移（CLNM）在不可切除的胸段食管鳞状细胞癌（SCC）患者中的预后意义，并识别这些患者的重要预后因素。
这项回顾性研究纳入了395例接受同步放化疗的不可切除食管SCC患者。根据颈部淋巴结状态将患者分为三组：A组，无CLNM证据；B组，单侧CLNM；C组，其他远处转移。计算总生存期（OS）和无进展生存期（PFS）。使用单因素和多因素分析确定重要预后因素。
A、B和C组的3年OS率分别为46.7%、33.5%和8.3%（p<0.001，对数秩检验）。相应的PFS率分别为40.7%、26.4%和4.7%（p<0.001，对数秩检验）。B组的预后与A组相似，且3年OS率（p = 0.009）和PFS率（p = 0.006）均优于C组。多因素分析表明，T分期、化疗方案和颈部淋巴结受累是影响OS和PFS的独立预后因素。
与其他远处转移相比，单侧CLNM在食管SCC中与更长的OS相关，应被视为区域性疾病。性别、T分期、同步化疗方式和颈部淋巴结受累是食管SCC生存的独立预测因素。
