Okamura Akihiko, Watanabe Masayuki, Kozuki Ryotaro, Toihata Tasuku, Yuda Masami, Imamura Yu, Mine Shinji
Department of Gastroenterological Surgery, Gastroenterology Center, The Cancer Institute Hospital of Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku, Tokyo, 135-8550, Japan.
Langenbecks Arch Surg. 2018 Dec;403(8):977-984. doi: 10.1007/s00423-018-1722-x. Epub 2018 Oct 25.
Squamous cell carcinoma of the middle thoracic esophagus (SCC-ME) often metastasizes to the neck, mediastinum, and abdomen. This study aims to assess the prognostic impact of supraclavicular (SC) and celiac (CE) lymph node (LN) metastases in patients with SCC-ME.
We examined 210 patients who underwent curative esophagectomy with three-field LN dissection for SCC-ME. The clinicopathological features and survival outcomes of patients with and without SC and/or CE metastases were compared to assess the prognostic significance of SC and/or CE metastases.
We observed metastases to SC and CE in 25 (11.9%) and 20 (9.5%) patients, respectively. Seven patients (3.3%) had both SC and CE metastases. Although the survival of patients with SC and/or CE metastases was worse compared with those without, that of patients with SC metastases but without CE metastases was comparable with that of patients with CE metastases but without SC metastases; the 5 year overall survival rates were 35.6% and 46.2%, respectively. However, survival of patients with both SC and CE metastases was the worst among all groups, and all patients with both SC and CE metastases experienced disease recurrence.
The prognosis of patients with both SC and CE metastases was extremely poor. In contrast, patients with metastasis to either one of these sites could be candidates for surgery as the main modality in a multidisciplinary strategy.
胸段中段食管癌（SCC - ME）常转移至颈部、纵隔和腹部。本研究旨在评估锁骨上（SC）和腹腔干（CE）淋巴结（LN）转移对SCC - ME患者预后的影响。
我们检查了210例行根治性食管切除术并进行三野淋巴结清扫的SCC - ME患者。比较有和无SC及/或CE转移患者的临床病理特征和生存结果，以评估SC和/或CE转移的预后意义。
我们分别观察到25例（11.9%）和20例（9.5%）患者发生SC和CE转移。7例患者（3.3%）同时有SC和CE转移。虽然有SC和/或CE转移患者的生存率低于无转移患者，但仅有SC转移而无CE转移患者的生存率与仅有CE转移而无SC转移患者的生存率相当；5年总生存率分别为35.6%和46.2%。然而，同时有SC和CE转移的患者在所有组中预后最差，且所有同时有SC和CE转移的患者均出现疾病复发。
同时有SC和CE转移患者的预后极差。相比之下，仅转移至其中一个部位的患者可作为多学科策略中以手术为主的治疗候选者。
