Esophageal Surgery Division, Department of Gastrointestinal Oncology, National Cancer Center Hospital, Tsukiji, Chuo-ku, Tokyo, Japan; Department of Esophageal Surgery, National Cancer Center Hospital East, Kashiwa, Chiba, Japan.
Esophageal Surgery Division, Department of Gastrointestinal Oncology, National Cancer Center Hospital, Tsukiji, Chuo-ku, Tokyo, Japan.
Surgery. 2019 Jun;165(6):1203-1210. doi: 10.1016/j.surg.2018.12.017. Epub 2019 Mar 6.
This study aimed to elucidate the impact of extranodal extension, pathologically assessed according to new diagnostic criteria, on the prognosis of esophageal squamous cell carcinoma. Extranodal extension has been shown to be a prognostic indicator for head and neck cancers; however, its utility in esophageal squamous cell carcinoma has not been demonstrated.
We enrolled 174 consecutive esophageal squamous cell carcinoma patients who had undergone esophagectomy with lymph node dissection in the three fields. Extranodal extensions from all metastatic lymph nodes were pathologically classified into grades 1-3. Then, relationships between extranodal extension and clinicopathologic factors, including overall survival and recurrence-free survival were examined. Recurrence patterns in the thoracic and abdominal fields were also examined.
Kaplan-Meier analyses showed that patients with grades 2 and 3 extranodal extension showed significantly poorer recurrence-free survival compared with those with intranodal involvement of esophageal squamous cell carcinoma cells (P = .0041 and P = .0011, respectively). Patients with pN3b (newly defined in this study as including at least one lymph node with grade 2-3 extranodal extension regardless of region or number of metastatic lymph nodes) was associated with significantly shorter overall survival and recurrence-free survival (P < .001). Moreover, multivariate analyses indicated that patients with grades 2-3 extranodal extension showed significantly reduced recurrence-free survival in the thoracic but not in the abdominal field (thoracic: P = .047; abdominal: P = .15).
This study suggests that the extranodal extension grading system proposed in this study is a novel predictor of overall survival and recurrence-free survival in esophageal squamous cell carcinoma.
本研究旨在阐明根据新的诊断标准评估的结外侵犯对食管鳞状细胞癌预后的影响。结外侵犯已被证明是头颈部癌症的预后指标；然而，其在食管鳞状细胞癌中的应用尚未得到证实。
我们纳入了 174 例连续接受了三野淋巴结清扫术的食管鳞状细胞癌患者。所有转移性淋巴结的结外延伸均通过病理分级为 1-3 级。然后，研究了结外延伸与临床病理因素（包括总生存和无复发生存）之间的关系。还检查了胸腹部的复发模式。
Kaplan-Meier 分析表明，与食管鳞状细胞癌细胞的淋巴结内侵犯相比，2 级和 3 级结外侵犯的患者无复发生存率显著降低（P=0.0041 和 P=0.0011）。在本研究中，新定义的 pN3b（包括至少一个有 2-3 级结外侵犯的淋巴结，无论区域或转移性淋巴结的数量如何）与总生存和无复发生存率显著缩短相关（P<0.001）。此外，多变量分析表明，2 级和 3 级结外侵犯的患者在胸部而非腹部的无复发生存率显著降低（胸部：P=0.047；腹部：P=0.15）。
本研究表明，本研究提出的结外延伸分级系统是食管鳞状细胞癌总生存和无复发生存的新预测指标。
