Department of Surgery, Guy's and St Thomas' Oesophago-Gastric Centre, London, UK.
Gastrointestinal Cancer, King's College London, London, UK.
Br J Surg. 2018 Nov;105(12):1639-1649. doi: 10.1002/bjs.10900. Epub 2018 Jul 26.
The aim was to define the pathological response in lymph nodes following neoadjuvant chemotherapy for oesophageal adenocarcinoma and to quantify any associated survival benefit.
Lymph nodes retrieved at oesophagectomy were examined retrospectively by two pathologists for evidence of a response to chemotherapy. Patients were classified as lymph node-negative (either negative nodes with no evidence of previous tumour involvement or negative with evidence of complete regression) or positive (allocated a lymph node regression score based on the proportion of fibrosis to residual tumour). Lymph node responders (score 1, complete response; 2, less than 10 per cent remaining tumour; 3, 10-50 per cent remaining tumour) and non-responders (score 4, more than 50 per cent viable tumour; 5, no response) were compared in survival analyses using Kaplan-Meier and Cox regression analysis.
Among 377 patients, 256 had neoadjuvant chemotherapy. Overall, 68 of 256 patients (26·6 per cent) had a lymph node response and 115 (44·9 per cent) did not. The remaining 73 patients (28·5 per cent) had negative lymph nodes with no evidence of regression. Some patients had a lymph node response in the absence of a response in the primary tumour (27 of 99, 27 per cent). Lymph node responders had a significant survival benefit (P < 0·001), even when stratified by patients with or without a response in the primary tumour. On multivariable analysis, lymph node responders had decreased overall (hazard ratio 0·53, 95 per cent c.i. 0·36 to 0·78) and disease-specific (HR 0·42, 0·27 to 0·66) mortality, and experienced reduced local and systemic recurrence.
Lymph node regression is a strong prognostic factor and may be more important than response in the primary tumour.
本研究旨在定义新辅助化疗后食管腺癌淋巴结的病理反应，并量化其与生存获益的关系。
回顾性分析行食管癌切除术患者的淋巴结，由两名病理学家评估其对化疗的反应。根据是否存在先前肿瘤累及或是否存在完全消退的证据，将淋巴结分为阴性（无阳性淋巴结或阴性伴完全消退）或阳性（根据纤维化与残留肿瘤的比例分配淋巴结消退评分）。采用 Kaplan-Meier 和 Cox 回归分析比较淋巴结反应者（评分 1，完全缓解；2，残留肿瘤<10%；3，残留肿瘤 10-50%）和非反应者（评分 4，残留肿瘤>50%；5，无反应）的生存情况。
在 377 例患者中，256 例接受了新辅助化疗。总体而言，256 例患者中有 68 例（26.6%）发生淋巴结反应，115 例（44.9%）未发生反应，73 例（28.5%）为阴性淋巴结且无消退证据。一些患者的原发肿瘤无反应而出现淋巴结反应（99 例中的 27 例，27.3%）。淋巴结反应者的生存获益显著（P<0.001），即使在原发肿瘤有或无反应的患者中分层也是如此。多变量分析显示，淋巴结反应者的总生存率（HR 0.53，95%CI 0.36 至 0.78）和疾病特异性生存率（HR 0.42，0.27 至 0.66）均降低，局部和全身复发率降低。
淋巴结消退是一个强有力的预后因素，可能比原发肿瘤的反应更重要。
