Peng Jun, Wang Wen-Ping, Yuan Yong, Wang Zhi-Qiang, Wang Yun, Chen Long-Qi
Department of Thoracic Surgery, West China Hospital of Sichuan University, Chengdu, Sichuan, China.
Department of Thoracic Surgery, West China Hospital of Sichuan University, Chengdu, Sichuan, China
Eur J Cardiothorac Surg. 2016 May;49(5):e141-6. doi: 10.1093/ejcts/ezw015. Epub 2016 Feb 22.
The seventh edition of the American Joint Committee on Cancer (AJCC) tumour-node-metastasis (TNM) staging system for oesophageal cancer did not define the minimal requirement for an adequate extent of lymphadenectomy in patients with oesophageal cancer. This study aimed to define the minimum number of lymph node (LN) stations to be resected in patients with oesophageal squamous cell carcinoma (OSCC).
We conducted a retrospective review of clinicopathological data from 2033 patients with OSCC undergoing complete resection between August 2005 and September 2013. An ordinal logistic regression analysis was used to identify the variables associated with revised N (rN) staging progression and indices that could be used in the stratified analysis. To determine the optimal number of resected LN stations, we compared the overall survival hazard ratio between groups with different numbers of LN stations using a Cox's proportional hazards regression model. The highest χ(2) value was deemed the cut-off point.
The progression of rN staging was influenced by T-staging, G-staging, tumour length (>3 cm), lymphovascular invasion and number of resected LN stations. According to Cox's proportional hazards regression model, we recommended that at least six LN stations should be removed. Then, we conducted a stratified analysis by G status and tumour length. We found that at least seven LN stations should be removed in patients with G3 or tumour length >3 cm.
For thoracic OSCC, at least six LN stations had to be removed. Furthermore, for patients with G3 or tumour length >3 cm, the recommendation was seven.
美国癌症联合委员会（AJCC）食管癌肿瘤-淋巴结-转移（TNM）分期系统第七版未明确食管癌患者进行充分淋巴结清扫的最低要求。本研究旨在确定食管鳞状细胞癌（OSCC）患者需切除的最少淋巴结站数。
我们对2005年8月至2013年9月期间接受根治性切除的2033例OSCC患者的临床病理数据进行了回顾性分析。采用有序逻辑回归分析来确定与修订后的N（rN）分期进展相关的变量以及可用于分层分析的指标。为确定切除淋巴结站数的最佳数量，我们使用Cox比例风险回归模型比较了不同淋巴结站数组之间的总生存风险比。最高χ(2)值被视为分界点。
rN分期进展受T分期、G分期、肿瘤长度（>3 cm）、脉管侵犯和切除淋巴结站数影响。根据Cox比例风险回归模型，我们建议至少切除6个淋巴结站。然后，我们按G状态和肿瘤长度进行了分层分析。我们发现G3或肿瘤长度>3 cm的患者至少应切除7个淋巴结站。
对于胸段OSCC，至少需切除6个淋巴结站。此外，对于G3或肿瘤长度>3 cm的患者，建议切除7个淋巴结站。
