原发性食管癌根治术后淋巴结阴性患者的淋巴管脉管侵犯是主要预后因素。
Lymphovascular Invasion as the Major Prognostic Factor in Node-Negative Esophageal Cancer After Primary Esophagectomy.
机构信息
School of Medicine, National Yang-Ming University, Taipei, Taiwan.
Division of Thoracic Surgery, Department of Surgery, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, 707, Sec 3, Chung-Yang Rd., 970, Hualien, Taiwan.
出版信息
J Gastrointest Surg. 2020 Jul;24(7):1459-1468. doi: 10.1007/s11605-019-04310-0. Epub 2019 Jul 3.
BACKGROUND
Studies addressing both lymphovascular invasion (LVI) and perineural invasion (PNI) in patients with esophageal squamous cell carcinoma (ESCC) treated with or without neoadjuvant therapy are limited. We aimed to analyze the incidence and prognostic significance of LVI and PNI in patients with thoracic ESCC.
METHODS
This retrospective study included 520 patients with ESCC: 174 patients after neoadjuvant treatment followed by surgery and 346 after primary esophagectomy, from two medical centers. The relationships between LVI, PNI, and other histological factors were evaluated. The Cox regression model was used for survival analysis.
RESULTS
Positive LVI and PNI were noted in 35.6% and 22.4% of patients with residual primary tumor after neoadjuvant treatment and in 39.6% and 24.0% of patients who underwent primary esophagectomy, respectively. In patients with neoadjuvant treatments, the 5-year overall survival rates were 12.7% and 28.3% in patients with positive LVI and negative LVI, respectively (p = 0.001). The 5-year overall survival rates were 6.4% and 29.9% in patients with positive PNI and negative PNI, respectively (p < 0.001). In patients who did not receive neoadjuvant treatment, the 5-year overall survival rates were 28.2% and 61.1% in patients with positive LVI and negative LVI, respectively (p < 0.001). The 5-year overall survival rates were 30.2% and 52.5% in patients with positive PNI and negative PNI (p < 0.001). In subgroup analysis, the presence of PNI was an independent prognostic factor in patients with neoadjuvant treatments, whereas the presence of LVI had more significant prognostic impact in patients with node-negative ESCC after primary esophagectomy.
CONCLUSIONS
Both LVI and PNI statuses are significant prognostic factors for patients with ESCC. However, the prognostic impact of LVI was majorly in the subgroup of node-negative patients who received primary esophagectomy.
背景
针对接受新辅助治疗或未接受新辅助治疗的食管鳞癌（ESCC）患者的淋巴血管侵犯（LVI）和神经周围侵犯（PNI）进行研究的文献有限。我们旨在分析胸段 ESCC 患者中 LVI 和 PNI 的发生率和预后意义。
方法
本回顾性研究纳入了来自两个医学中心的 520 例 ESCC 患者：174 例接受新辅助治疗后手术治疗，346 例接受单纯食管切除术。评估 LVI、PNI 与其他组织学因素之间的关系。采用 Cox 回归模型进行生存分析。
结果
新辅助治疗后残留原发肿瘤患者中，LVI 和 PNI 阳性率分别为 35.6%和 22.4%，单纯食管切除术患者中，LVI 和 PNI 阳性率分别为 39.6%和 24.0%。新辅助治疗组中，LVI 阳性患者的 5 年总生存率为 12.7%，阴性患者为 28.3%（p=0.001）。PNI 阳性患者的 5 年总生存率为 6.4%，阴性患者为 29.9%（p<0.001）。未接受新辅助治疗的患者中，LVI 阳性患者的 5 年总生存率为 28.2%，阴性患者为 61.1%（p<0.001）。PNI 阳性患者的 5 年总生存率为 30.2%，阴性患者为 52.5%（p<0.001）。亚组分析显示，PNI 阳性是新辅助治疗患者的独立预后因素，而 LVI 阳性在单纯食管切除术的淋巴结阴性 ESCC 患者中具有更显著的预后影响。
结论
LVI 和 PNI 状态均是 ESCC 患者的重要预后因素。然而，LVI 的预后影响主要在接受单纯食管切除术且淋巴结阴性的患者亚组中。
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