ypT0N+：食管癌新辅助放化疗后出现肿瘤病理完全缓解但伴有残留淋巴结疾病的特殊患者，怎么回事？
ypT0N+: the unusual patient with pathological complete tumor response but with residual lymph node disease after neoadjuvant chemoradiation for esophageal cancer, what's up?
作者信息
Depypere Lieven Peter, Vervloet Gil, Lerut Toni, Moons Johnny, De Hertogh Gert, Sagaert Xavier, Coosemans Willy, Van Veer Hans, Nafteux Philippe Robert
机构信息
Department of Thoracic Surgery, University Hospitals Leuven, Leuven, Belgium.
Department of Pathology, University Hospitals Leuven, Leuven, Belgium.
出版信息
J Thorac Dis. 2018 May;10(5):2771-2778. doi: 10.21037/jtd.2018.04.136.
BACKGROUND
Little is known about the prognostic significance of residual nodal disease in otherwise complete pathologic responders (ypT0N+) after neoadjuvant chemoradiation (nCRT) for esophageal cancer (EC). The purpose is to analyze the long-term outcomes of EC patients with ypT0N+ following nCRT and esophagectomy.
METHODS
From a single institution database, 466 consecutive EC patients undergoing esophagectomy after nCRT were collected (1996-2016). ypT0N+ responders were compared to pathological complete responders (ypT0N0) and to pathological non-complete responders (ypT+N0 and ypT+N+).
RESULTS
There were 149 ypT0N0, 31 ypT0N+, 141 ypT+N0 and 145 ypT+N+. Median overall survival (OS) was worse in ypT0N+ (21.7 months) and ypT+N+ (16.8 months) compared to ypT0N0 (55.2 months) and ypT+N0 (42.0 months). Stratification by histology revealed a significant difference in prevalence of ypT0: 62.5% in 184 squamous cell carcinomas (SCC) compared to 23.0% in 282 adenocarcinomas (ADC) (P<0.0001) but not in ypT0N+ (15% . 22% respectively, P=0.25). In ADC, locoregional recurrence in ypT0N+ (43%) was comparable to ypT+N+ (31%) and more common compared to ypT0N0 (7%) and ypT+N0 (10%), reflected in median OS rates of 20.6, 17.5, 53.0 and 36.6 months respectively. Median OS in ADC is significantly determined by number of positive lymph nodes, being 21.7 months for pN1 and 2.7 months for pN2/3 (P=0.005) in ypT0N+ and 33.7 months for pN1 and 16.2 months for pN2/3 (P=0.031) in ypT+N+. In SCC, locoregional recurrences were found in 17% of ypT0N+, 33% of ypT+N+, 11% of ypT0N0 and 22% in ypT+N0 and median OS was 26.6, 15.6, 55.2 and 43.8 months respectively. In SCC ypN+ number of affected lymph nodes showed no difference on OS.
CONCLUSIONS
ypT0N+ in EC patients following nCRT has a poor prognosis and behaves similar to ypT+N+. However, stratification by histology shows that this is especially true in ADC but seems determined by the number of involved lymph nodes.
背景
对于接受新辅助放化疗（nCRT）的食管癌（EC）患者，在其他方面为病理完全缓解者（ypT0N+）中，残留淋巴结疾病的预后意义知之甚少。目的是分析接受nCRT和食管切除术后ypT0N+的EC患者的长期预后。
方法
从一个单一机构数据库中，收集了466例接受nCRT后行食管切除术的连续EC患者（1996 - 2016年）。将ypT0N+缓解者与病理完全缓解者（ypT0N0）以及病理非完全缓解者（ypT+N0和ypT+N+）进行比较。
结果
有149例ypT0N0、31例ypT0N+、141例ypT+N0和145例ypT+N+。与ypT0N0（55.2个月）和ypT+N0（42.0个月）相比，ypT0N+（21.7个月）和ypT+N+（16.8个月）的中位总生存期（OS）较差。按组织学分层显示ypT0的患病率有显著差异：184例鳞状细胞癌（SCC）中为62.5%，而282例腺癌（ADC）中为23.0%（P<0.0001），但ypT0N+中无差异（分别为15%和22%，P = 0.25）。在ADC中，ypT0N+的局部区域复发率（43%）与ypT+N+（31%）相当，且比ypT0N0（7%）和ypT+N0（10%）更常见，中位OS率分别为20.6、17.5、53.0和36.6个月。ADC中的中位OS显著取决于阳性淋巴结数量，ypT0N+中pN1为21.7个月，pN2/3为2.7个月（P = 0.005），ypT+N+中pN1为33.7个月，pN2/3为16.2个月（P = 0.031）。在SCC中，ypT0N+的17%、ypT+N+的33%、ypT0N0的11%和ypT+N0的22%出现局部区域复发，中位OS分别为26.6、15.6、55.2和43.8个月。在SCC中，ypN+受累淋巴结数量对OS无差异。
结论
nCRT后的EC患者中ypT0N+预后不良，其行为与ypT+N+相似。然而，按组织学分层显示，这在ADC中尤其如此，但似乎由受累淋巴结数量决定。
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