Department of Radiation Oncology, Shanghai Chest Hospital, Shanghai Jiao Tong University, China.
Department of Radiation Oncology, Fudan University Shanghai Cancer Center, China; Department of Oncology, Fudan University, Shanghai, China.
Radiother Oncol. 2014 Nov;113(2):175-81. doi: 10.1016/j.radonc.2014.11.022. Epub 2014 Nov 26.
To propose revisions of CT-based cervical and thoracic lymph node levels for esophageal cancer in UICC 7th version.
One hundred and forty-nine patients who underwent surgery were analyzed retrospectively for hypothesis validation, 338 patients who underwent definitive radiotherapy to evaluate the feasibility in clinical work, and 121 patients from another independent cohort for external evaluation. We redefined Level VI in the RTOG consensus guideline of CT-based cervical lymph node levels, and established a new Level 1 in the IASLC guideline of CT-based thoracic lymph node levels. We also shrunk Level 3p. Lymph nodes were assigned into different levels by three criteria.
We encountered stratification problems in 63 patients by JSED criteria and in 24 patients by RTOG criteria. Multivariate analysis showed that nodal status was independently associated with OS in the three cohorts (p<0.001). No significant difference was found between the Level 1 only group and the mediastinal nodes only group (p>0.05).
The proposed hypothesis clearly defined the boundary area between the cervical and thoracic parts, brought more convenience for stratification, better predicted patients' OS and provided information for both pre-treatment evaluation and multidisciplinary treatment planning.
为了对 UICC 第 7 版食管癌的 CT 颈胸淋巴结分区进行修订。
回顾性分析了 149 例行手术治疗的患者以验证假设，对 338 例行根治性放疗的患者进行评估以检验其在临床工作中的可行性，并对来自另一个独立队列的 121 例患者进行外部评估。我们重新定义了 RTOG 基于 CT 的颈淋巴结分区共识指南中的 Level VI，并在 IASLC 基于 CT 的胸淋巴结分区指南中建立了新的 Level 1。我们还缩小了 Level 3p。根据三个标准将淋巴结分配到不同的水平。
JSED 标准和 RTOG 标准分别使 63 例和 24 例患者的分层出现问题。多变量分析显示，淋巴结状态与三个队列的 OS 独立相关（p<0.001）。仅包括 Level 1 组和仅包括纵隔淋巴结组之间无显著差异（p>0.05）。
所提出的假设清楚地定义了颈部和胸部之间的边界区域，为分层带来了更多便利，更好地预测了患者的 OS，并为治疗前评估和多学科治疗计划提供了信息。
