Wang Zhi-Qiang, Deng Han-Yu, Hu Yang, Yuan Yong, Wang Wen-Ping, Wang Yun-Cang, Chen Long-Qi
Department of Thoracic Surgery, West China Hospital of Sichuan University, Chengdu 610041, China;; Department of Thoracic Surgery, Chongqing Cancer Institute, Chongqing 400030, China.
Department of Thoracic Surgery, West China Hospital of Sichuan University, Chengdu 610041, China.
J Thorac Dis. 2016 Dec;8(12):3625-3632. doi: 10.21037/jtd.2016.12.50.
The prognostic value of the right upper mediastinal lymph node dissection (RUMLND) for patients with middle or lower thoracic esophageal squamous cell carcinoma (ESCC-MLT) is still not well established yet. Our objective is to evaluate the prognostic role of the Sweet procedure plus right upper mediastinal lymph node dissection (MS) by comparing with the Sweet procedure with standard lymph node dissection (SS) in terms of long-term survival.
Totally 1,477 ESCC-MLT patients underwent radical intent surgery (186 with MS, 1,291 with SS) at our department between January 2007 and September 2013. After propensity score matching (PSM), 186 patients from each group were matched and analyzed. The 5-year survival rates in two groups were compared by detailed stratifications in terms of clinical characteristics.
As for the prognostic role of RUMLND, patients treated with MS tended to obtain higher 5-year survival rate than patients treated with SS in univariate analysis (48.1% 37.4%). Moreover, in multivariate analysis, MS yielded significant higher 5-year survival rate compared with SS (P=0.041). In addition, subgroup analyses of the survival between the MS and SS patients by detailed stratifications demonstrated the survival superiority in the MS group with age <60 years old, TNM stage III, number of lymph node dissection (LND) ≥15, as well as no using of postoperative adjuvant treatment.
The RUMLND in Sweet procedure is an independent prognostic factor for ESCC-MLT patients, especially for those with thoracic middle segment-located tumor, stage III or younger.
对于中下段胸段食管鳞状细胞癌（ESCC-MLT）患者，右上纵隔淋巴结清扫术（RUMLND）的预后价值尚未完全明确。我们的目的是通过比较Sweet手术联合右上纵隔淋巴结清扫术（MS）与Sweet手术联合标准淋巴结清扫术（SS）的长期生存率，评估MS的预后作用。
2007年1月至2013年9月期间，共有1477例ESCC-MLT患者在我科接受了根治性手术（186例行MS，1291例行SS）。在进行倾向评分匹配（PSM）后，对每组186例患者进行匹配和分析。根据临床特征进行详细分层，比较两组的5年生存率。
关于RUMLND的预后作用，在单因素分析中，接受MS治疗的患者5年生存率倾向于高于接受SS治疗的患者（48.1%对37.4%）。此外，在多因素分析中，与SS相比，MS的5年生存率显著更高（P=0.041）。此外，通过详细分层对MS组和SS组患者的生存情况进行亚组分析显示，年龄<60岁、TNM分期III期、淋巴结清扫（LND）数量≥15以及未使用术后辅助治疗的MS组患者生存优势明显。
Sweet手术中的RUMLND是ESCC-MLT患者的独立预后因素，尤其是对于那些肿瘤位于胸段中段、III期或更年轻的患者。
