Chao Yin-Kai, Chen Hui-Shan, Wang Bing-Yen, Hsu Po-Kuei, Liu Chia-Chuan, Wu Shiao-Chi
Division of Thoracic Surgery, Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Taoyuan, Taiwan.
Institute of Health and Welfare Policy, National Yang-Ming University, Taipei, Taiwan.
Ann Thorac Surg. 2016 May;101(5):1897-902. doi: 10.1016/j.athoracsur.2015.11.052. Epub 2016 Feb 22.
Few data are available on the survival outcomes of patients with esophageal squamous cell carcinoma who achieve complete response at the primary site but have residual nodal metastases after chemoradiotherapy. We sought to assess the survival of esophageal squamous cell carcinoma patients with ypT0 N+ disease.
Esophageal squamous cell carcinoma patients treated with chemoradiotherapy and esophagectomy were identified from the Taiwan Cancer Registry between 2008 and 2013. We compared the clinical and survival data of ypT0 N+ and ypT0 N0 patients. The median number of dissected nodes (n = 20) was used as the cutoff to classify the extent of lymph node dissection (LND). Survival data were analyzed with the Kaplan-Meier method and Cox proportional hazards regression models.
The study included 369 ypT0 patients (50 ypT0 N+ [13.6%] and 319 ypT0 N0 [86.4%]). The 3-year overall survival was significantly lower in ypT0 N+ patients (30.1%) than in ypT0 N0 patients (55.9%, p < 0.001). Multivariate analysis showed that a higher number of positive lymph nodes (ypN2/N3 vs ypN1) was a strong adverse prognostic factor (hazard ratio, 3.76; p = 0.011) in ypT0 N+ patients. The extent of LND was identified as an independent predictor of survival in patients with ypT0 N0 disease (low vs high; hazard ratio, 1.49; p = 0.045). A stepwise decrease in 3-year overall survival rates was observed in the following groups: ypT0 N0 with high LND (61.2%), ypT0 N0 with low LND (50.3%), and ypT0 N+ (30.1%, p < 0.001).
At least 13.6% of ypT0 patients have lymph node metastases, which carry adverse prognostic implications. The number of positive nodes is the most important prognostic factor in this group.
关于食管鳞状细胞癌患者在原发部位达到完全缓解但在放化疗后有残留淋巴结转移的生存结局，目前可用的数据较少。我们试图评估ypT0 N+期食管鳞状细胞癌患者的生存情况。
从台湾癌症登记处中识别出2008年至2013年间接受放化疗及食管切除术治疗的食管鳞状细胞癌患者。我们比较了ypT0 N+和ypT0 N0患者的临床及生存数据。将清扫淋巴结的中位数（n = 20）作为划分淋巴结清扫范围（LND）的界值。生存数据采用Kaplan-Meier法和Cox比例风险回归模型进行分析。
该研究纳入了369例ypT0患者（50例ypT0 N+ [13.6%]和319例ypT0 N0 [86.4%]）。ypT0 N+患者的3年总生存率（30.1%）显著低于ypT0 N0患者（55.9%，p < 0.001）。多因素分析显示，在ypT0 N+患者中，阳性淋巴结数量较多（ypN2/N3 vs ypN1）是一个强烈的不良预后因素（风险比，3.76；p = 0.011）。LND范围被确定为ypT0 N0期患者生存的独立预测因素（低LND vs 高LND；风险比，1.49；p = 0.045）。在以下组中观察到3年总生存率逐步下降：高LND的ypT0 N0（61.2%）、低LND的ypT0 N0（50.3%）和ypT0 N+（30.1%，p < 0.001）。
至少13.6%的ypT0患者有淋巴结转移，这具有不良预后意义。阳性淋巴结数量是该组中最重要的预后因素。
