Sugawara Kotaro, Yamashita Hiroharu, Uemura Yukari, Mitsui Takashi, Yagi Koichi, Nishida Masato, Aikou Susumu, Mori Kazuhiko, Nomura Sachiyo, Seto Yasuyuki
Department of Gastrointestinal Surgery, Graduate School of Medicine, University of Tokyo, Tokyo, Japan.
Department of Gastrointestinal Surgery, Graduate School of Medicine, University of Tokyo, Tokyo, Japan.
Surgery. 2017 Oct;162(4):846-856. doi: 10.1016/j.surg.2017.06.013. Epub 2017 Jul 21.
The current eighth tumor node metastasis lymph node category pathologic lymph node staging system for esophageal squamous cell carcinoma is based solely on the number of metastatic nodes and does not consider anatomic distribution. We aimed to assess the prognostic capability of the eighth tumor node metastasis pathologic lymph node staging system (numeric-based) compared with the 11th Japan Esophageal Society (topography-based) pathologic lymph node staging system in patients with esophageal squamous cell carcinoma.
We retrospectively reviewed the clinical records of 289 patients with esophageal squamous cell carcinoma who underwent esophagectomy with extended lymph node dissection during the period from January 2006 through June 2016. We compared discrimination abilities for overall survival, recurrence-free survival, and cancer-specific survival between these 2 staging systems using C-statistics.
The median number of dissected and metastatic nodes was 61 (25% to 75% quartile range, 45 to 79) and 1 (25% to 75% quartile range, 0 to 3), respectively. The eighth tumor node metastasis pathologic lymph node staging system had a greater ability to accurately determine overall survival (C-statistics: tumor node metastasis classification, 0.69, 95% confidence interval, 0.62-0.76; Japan Esophageal Society classification; 0.65, 95% confidence interval, 0.58-0.71; P = .014) and cancer-specific survival (C-statistics: tumor node metastasis classification, 0.78, 95% confidence interval, 0.70-0.87; Japan Esophageal Society classification; 0.72, 95% confidence interval, 0.64-0.80; P = .018). Rates of total recurrence rose as the eighth tumor node metastasis pathologic lymph node stage increased, while stratification of patients according to the topography-based node classification system was not feasible.
Numeric nodal staging is an essential tool for stratifying the oncologic outcomes of patients with esophageal squamous cell carcinoma even in the cohort in which adequate numbers of lymph nodes were harvested.
目前用于食管鳞状细胞癌的第八版肿瘤淋巴结转移（TNM）病理淋巴结分期系统仅基于转移淋巴结的数量，未考虑解剖分布。我们旨在评估第八版TNM病理淋巴结分期系统（基于数字）与第11版日本食管癌学会（基于拓扑结构）病理淋巴结分期系统相比，在食管鳞状细胞癌患者中的预后评估能力。
我们回顾性分析了2006年1月至2016年6月期间289例行食管切除术并扩大淋巴结清扫术的食管鳞状细胞癌患者的临床记录。我们使用C统计量比较了这两种分期系统在总生存、无复发生存和癌症特异性生存方面的区分能力。
切除和转移淋巴结的中位数分别为61个（四分位数间距，45至79个）和1个（四分位数间距，0至3个）。第八版TNM病理淋巴结分期系统在准确判断总生存（C统计量：TNM分类，0.69，95%置信区间，0.62 - 0.76；日本食管癌学会分类，0.65，95%置信区间，0.58 - 0.71；P = 0.014）和癌症特异性生存（C统计量：TNM分类，0.78，95%置信区间，0.70 - 0.87；日本食管癌学会分类，0.72，95%置信区间，0.64 - 0.80；P = 0.018）方面能力更强。随着第八版TNM病理淋巴结分期的增加，总复发率上升，而根据基于拓扑结构的淋巴结分类系统对患者进行分层是不可行的。
即使在清扫了足够数量淋巴结的队列中，数字淋巴结分期也是分层评估食管鳞状细胞癌患者肿瘤学结局的重要工具。
