Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, Osaka, Japan.
Department of Surgery, Osaka General Medical Center, Osaka, Japan.
Ann Surg. 2021 Jun 1;273(6):1141-1149. doi: 10.1097/SLA.0000000000003445.
The aim of this study was to evaluate primary tumor (PT) and lymph node (LN) responses to neoadjuvant chemotherapy (NACT) for predicting long-term survival in patients with metastatic esophageal cancer (EC).
In evaluating NACT responses in patients with EC, imaging modalities typically target the PT in the esophagus, which is unmeasurable. Targeting measurable organs, like positive LNs, might provide more accurate assessments.
We enrolled 251 patients with EC and clinically positive LNs that underwent curative resections, after triplet NACT. The percent reduction of PT area was measured with bidimensional computed tomography. The LN response was defined as the percent reduction of the sum of the short diameters in all positive LNs.
NACT reduced PTs and LNs by (median, range) 58.0% (38.1-94.9) and 34.5% (46.2-68.2), respectively. Based on the receiver-operating characteristic analyses for predicting a histological response and a 10% stepwise cutoff analyses of recurrence-free survival (RFS), responder/nonresponder cutoff values were ≥60% for PT area reductions and ≥30% for LN size reductions. 39.6% of patients showed discordant PT and LN responses. Compared with PT-responders, LN-responders had significantly less advanced pN (P < 0.0001) and pM (P = 0.015) in addition to less advanced pT (P < 0.0001) and better histological responses (P < 0.0001), and closer correlations to lymphatic, distant metastases and dissemination. A multivariate analysis of RFS identified 2 independent prognostic factors: the LN response [hazard ratio (HR) = 2.51, 95% confidence interval (CI) = 1.63-3.95, P < 0.0001] and the pN (HR = 2.72, 95% CI = 1.44-5.64, P = 0.0016), but not the PT response.
The LN response to NACT predicted long-term survival more precisely than the PT response in patients with metastatic EC.
本研究旨在评估新辅助化疗（NACT）后原发肿瘤（PT）和淋巴结（LN）的反应，以预测转移性食管癌（EC）患者的长期生存。
在评估 EC 患者的 NACT 反应时，成像方式通常针对食管中不可测量的 PT。针对可测量的器官，如阳性 LN，可能会提供更准确的评估。
我们纳入了 251 例接受三联 NACT 后行根治性切除术且临床阳性 LN 的 EC 患者。通过二维计算机断层扫描测量 PT 面积的减少百分比。LN 反应定义为所有阳性 LN 短径总和的减少百分比。
NACT 分别使 PT 和 LN 减少（中位数，范围）58.0%（38.1-94.9）和 34.5%（46.2-68.2）。基于预测组织学反应的受试者工作特征分析和 10%逐步截距分析无复发生存率（RFS），PT 面积减少≥60%和 LN 大小减少≥30%为反应者/非反应者的截断值。39.6%的患者出现 PT 和 LN 反应不一致。与 PT 反应者相比，LN 反应者的 pN（P<0.0001）和 pM（P=0.015）分期更晚，pT（P<0.0001）分期更早，组织学反应更好，且与淋巴、远处转移和播散更密切相关。RFS 的多变量分析确定了 2 个独立的预后因素：LN 反应[风险比（HR）=2.51，95%置信区间（CI）=1.63-3.95，P<0.0001]和 pN（HR=2.72，95%CI=1.44-5.64，P=0.0016），而不是 PT 反应。
在转移性 EC 患者中，与 PT 反应相比，NACT 后 LN 反应更能准确预测长期生存。
