Department of Gastroenterology and Endoscopy, National Cancer Center Hospital East, Kashiwa, Chiba, Japan.
Department of Gastroenterology and Gastrointestinal Oncology, National Cancer Center Hospital East, Kashiwa, Chiba, Japan.
Cancer Sci. 2018 Jun;109(6):2046-2055. doi: 10.1111/cas.13596. Epub 2018 May 3.
Tumor regression grade of the primary tumor (TRG-PT) and residual lymph node metastasis have been pathologically determined in esophageal squamous cell carcinoma (ESCC) patients who had received neoadjuvant chemotherapy (nCT) followed by surgery; however, TRG of the metastatic tumor involving lymph nodes (LN) has not yet been determined. The aim of the present study was to clarify the impact of TRG on the prognosis of ESCC patients. ESCC patients (n = 110) who had received nCT followed by surgery were enrolled. Dissected LN were classified into 2 categories: plausible positive metastatic LN (pp-MLN) where viable and/or degenerated ESCC cells and/or tissue modifications were observed, and non-metastatic LN (non-MLN) where neither of them was observed. We defined nCT-effective rate (CER) as the ratio of the number of pp-MLN that showed tumor regression to the total number of pp-MLN, and divided CER into low-CER (LCER; ≥0% and <50%) and high-CER (HCER; ≥50% and ≤100%). Relationships between CER and clinicopathological factors including prognosis were then examined. Multivariate analyses of 110 patients indicated that ypT3-4 (P = .023, HR; 2.551), positive venous infiltration (P = .006, HR; 3.526), and LCER (P = .033, HR; 1.922) were independently associated with shorter recurrence-free survival (RFS). Multivariate analyses of 43 patients with grade 0 TRG-PT showed that ypT3-4 (P = .033, HR; 3.397) and LCER (P = .008, HR; 3.543) were independently associated with shorter RFS. This study showed that CER was one of the prognostic factors for ESCC patients who had received nCT followed by surgery.
在接受新辅助化疗（nCT）加手术治疗的食管鳞癌（ESCC）患者中，已经通过病理确定了原发肿瘤的肿瘤退缩分级（TRG-PT）和残留淋巴结转移情况；然而，尚未确定涉及淋巴结（LN）的转移性肿瘤的 TRG。本研究旨在阐明 TRG 对 ESCC 患者预后的影响。本研究纳入了 110 例接受 nCT 加手术治疗的 ESCC 患者。对解剖的淋巴结进行了 2 类分类：有活性和/或退化的 ESCC 细胞和/或组织改变的可疑阳性转移性淋巴结（pp-MLN），以及未观察到上述任何改变的非转移性淋巴结（non-MLN）。我们将 nCT 有效率（CER）定义为显示肿瘤消退的 pp-MLN 数量与总 pp-MLN 数量的比值，并将 CER 分为低 CER（LCER；≥0%且<50%）和高 CER（HCER；≥50%且≤100%）。然后检查了 CER 与包括预后在内的临床病理因素之间的关系。对 110 例患者的多变量分析表明，ypT3-4（P=0.023，HR；2.551）、阳性静脉浸润（P=0.006，HR；3.526）和 LCER（P=0.033，HR；1.922）与较短的无复发生存（RFS）独立相关。对 43 例 TRG-PT 分级为 0 级的患者进行的多变量分析显示，ypT3-4（P=0.033，HR；3.397）和 LCER（P=0.008，HR；3.543）与较短的 RFS 独立相关。这项研究表明，CER 是接受 nCT 加手术治疗的 ESCC 患者的预后因素之一。
