Department of Molecular Medicine and Surgery, Karolinska Institutet, Karolinska University Hospital, 171 76 Stockholm, Sweden.
Department of Surgical and Perioperative Sciences, Umeå University, Umeå, Sweden.
Sci Rep. 2017 Mar 3;7:43744. doi: 10.1038/srep43744.
It is uncertain whether coeliac node metastasis precludes long-term survival in distal oesophageal cancer. This nationwide population-based cohort study included patients who underwent surgical resection for stage III or IV distal oesophageal cancer in 1987-2010 with follow-up until 2014. A minority (17.0%) had neoadjuvant therapy. The prognosis in patients with coeliac node metastasis was compared with patients with no such metastasis and patients with more distant metastasis. Multivariable Cox proportional-hazards regression models provided hazard ratios (HRs) with 95% confidence intervals (CIs) of disease-specific and overall mortality. Among 446 patients, 346 (77.6%) had no coeliac node metastasis, 56 (12.6%) had coeliac node metastasis, and 44 (9.9%) had more distant metastasis. Compared to coeliac node negative patients, coeliac node positive patients were at a 52% increased risk of disease-specific mortality (HR = 1.52, 95% CI 1.10-2.10), while patients with more distant metastasis had a 27% statistically non-significant increase (HR = 1.27, 95% CI 0.88-1.83). Patients with distant metastasis had no increase in disease-specific mortality compared to those with coeliac node metastasis (HR 0.71, 95% CI 0.40-1.27). Thus, patients with distal oesophageal cancer with coeliac node metastasis seem to have a similarly poor survival as patients with more distant metastasis, and thus may not benefit from surgery.
在远端食管癌中，腹腔干淋巴结转移是否会影响长期生存尚不确定。这项全国范围内基于人群的队列研究纳入了 1987 年至 2010 年间接受 III 期或 IV 期远端食管癌手术切除且随访至 2014 年的患者。少数患者（17.0%）接受了新辅助治疗。比较了有腹腔干淋巴结转移、无腹腔干淋巴结转移和远处转移患者的预后。多变量 Cox 比例风险回归模型提供了疾病特异性和总死亡率的风险比（HR）及其 95%置信区间（CI）。在 446 例患者中，346 例（77.6%）无腹腔干淋巴结转移，56 例（12.6%）有腹腔干淋巴结转移，44 例（9.9%）有远处转移。与腹腔干淋巴结阴性患者相比，腹腔干淋巴结阳性患者疾病特异性死亡率增加 52%（HR=1.52，95%CI 1.10-2.10），而远处转移患者的增加具有统计学上的非显著性（HR=1.27，95%CI 0.88-1.83）。与腹腔干淋巴结转移患者相比，远处转移患者的疾病特异性死亡率无增加（HR 0.71，95%CI 0.40-1.27）。因此，有腹腔干淋巴结转移的远端食管癌患者的生存情况似乎与远处转移患者相似较差，因此可能无法从手术中获益。
