Department of Gastroenterological Surgery, Cancer Institute Hospital.
Clinical Trial Planning and Management, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Ariake, Koto-ku, Tokyo, Japan.
Dis Esophagus. 2019 Dec 30;32(11). doi: 10.1093/dote/doz002.
The distribution of mediastinal lymph node metastasis in patients with adenocarcinoma of the esophagogastric junction (AEG) remains unclear. Additionally, the distribution of nodal mediastinal metastasis from squamous cell carcinoma (SCC) of the lower esophagus with involvement of the esophagogastric junction remains unclear, given the very limited number of these patients. In this retrospective review, we compared the outcomes of radical lymphadenectomy of the mediastinum, including upper mediastinal lymphadenectomy, between patients with AEG and those with SCC. From 2005 to 2017, 69 consecutive patients underwent esophagectomy via right thoracotomy or minimally invasive esophagectomy for a Siewert type I or II tumor with esophageal invasion ≥3 cm. We analyzed the incidences of mediastinal lymph node metastasis in this group relative to those of 73 patients with SCC with involvement of the esophagogastric junction who consecutively underwent esophagectomy during the same period. Mediastinal lymph node metastasis was seen in 26 of 69 patients with AEG (38%), with upper, middle, lower mediastinal nodal metastasis instances of 20%, 17%, and 23%, respectively. Mediastinal lymph node metastasis was seen in 23 of 73 patients with SCC (32%), with upper, middle, lower mediastinal nodal metastasis instances of 12%, 16%, and 19%, respectively. This mediastinal lymph nodal metastasis distribution did not statistically differ between patients with AEG and those with SCC. The relapse-free survival outcomes were poor for patients with clinical (P < 0.01) or pathological (P < 0.01) nodal metastasis of the mediastinum with AEG. In contrast, patients with clinical or pathological mediastinal nodal metastases of SCC did not have extremely poor survival outcomes, compared to patients with AEG. Despite the limited dataset available for analysis, patients with AEG and those with SCC might exhibit similar incidences and distribution of mediastinal lymph node metastasis. However, the clinical or pathological metastasis of AEG to the mediastinum was associated with poor survival outcomes, even if radical mediastinal lymphadenectomy including the upper mediastinal lymphadenectomy was performed.
食管胃结合部腺癌（AEG）患者纵隔淋巴结转移的分布仍不清楚。此外，由于此类患者数量非常有限，下段食管鳞癌（SCC）累及食管胃结合部的患者纵隔淋巴结转移的分布也不清楚。在这项回顾性研究中，我们比较了 AEG 患者和 SCC 患者接受根治性纵隔淋巴结清扫术（包括上纵隔淋巴结清扫术）的结果。2005 年至 2017 年，69 例 Siewert Ⅰ型或Ⅱ型肿瘤且食管侵犯≥3cm 的患者经右开胸或微创食管切除术行食管切除术。我们分析了该组患者纵隔淋巴结转移的发生率，并与同期连续行食管切除术的 73 例 SCC 累及食管胃结合部的患者进行比较。69 例 AEG 患者中有 26 例（38%）发生纵隔淋巴结转移，上、中、下纵隔淋巴结转移的比例分别为 20%、17%和 23%。73 例 SCC 患者中有 23 例（32%）发生纵隔淋巴结转移，上、中、下纵隔淋巴结转移的比例分别为 12%、16%和 19%。AEG 和 SCC 患者的纵隔淋巴结转移分布无统计学差异。AEG 患者有临床（P<0.01）或病理（P<0.01）纵隔淋巴结转移的无复发生存结局较差。相比之下，AEG 患者与 SCC 患者的临床或病理纵隔淋巴结转移患者的生存结局并没有极差。尽管可用于分析的数据有限，但 AEG 患者和 SCC 患者可能具有相似的纵隔淋巴结转移发生率和分布。然而，AEG 即使行包括上纵隔淋巴结清扫术的根治性纵隔淋巴结清扫术，纵隔淋巴结转移仍与不良生存结局相关。
