Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, China.
Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China.
Thorac Cancer. 2019 Aug;10(8):1725-1735. doi: 10.1111/1759-7714.13144. Epub 2019 Jul 10.
Lower thoracic esophageal cancer (LTEC) with celiac node metastasis and upper thoracic esophageal cancer (UTEC) with supraclavicular node metastasis were previously categorized as M1a diseases. Our study aimed to investigate whether the clinical significance of supraclavicular and celiac lymph node metastasis should be reevaluated in thoracic esophageal cancer.
A total of 6178 patients with thoracic esophageal cancer were identified from the Surveillance, Epidemiology, and End Results (SEER) database during 2004-2015. Treatment strategies and outcomes (OS, overall survival; CSS, cancer-specific survival) of patients with different nodal status were reviewed. The Cox proportional hazards regression model was applied to evaluate the prognostic factors. Statistical analyses were performed in all subgroups.
Multivariate analysis identified supraclavicular node metastasis but not celiac node metastasis as an independent predictor of both OS and CSS in LTEC. However, metastasis to supraclavicular or celiac nodes was not an independent predictor of OS and CSS in UTEC. Surgery was not associated with increased OS and CSS for UTEC with celiac or supraclavicular node metastasis but was favored as a predictor of better OS and CSS for LTEC with celiac or supraclavicular node metastasis. Radiotherapy benefited OS and CSS in LTEC involving celiac or supraclavicular nodes and in UTEC involving celiac nodes, while only OS benefited from radiotherapy in UTEC involving supraclavicular nodes.
These results provide preliminary evidence that the clinical significance of supraclavicular and celiac lymph node metastasis should be reevaluated in thoracic esophageal cancer with different prognostic information according to the primary sites.
以前，下胸段食管癌（LTEC）合并腹腔淋巴结转移和上胸段食管癌（UTEC）合并锁骨上淋巴结转移被归类为 M1a 疾病。我们的研究旨在探讨在胸段食管癌中，锁骨上和腹腔淋巴结转移的临床意义是否需要重新评估。
本研究从 2004 年至 2015 年的监测、流行病学和最终结果（SEER）数据库中确定了 6178 例胸段食管癌患者。回顾了不同淋巴结状态患者的治疗策略和结局（OS，总生存期；CSS，癌症特异性生存期）。应用 Cox 比例风险回归模型评估预后因素。在所有亚组中进行了统计学分析。
多变量分析确定锁骨上淋巴结转移而非腹腔淋巴结转移是 LTEC 患者 OS 和 CSS 的独立预测因素。然而，锁骨上或腹腔淋巴结转移不是 UTEC 患者 OS 和 CSS 的独立预测因素。手术与 UTEC 患者的腹腔或锁骨上淋巴结转移后的 OS 和 CSS 增加无关，但有利于 LTEC 患者腹腔或锁骨上淋巴结转移后的 OS 和 CSS 增加。放疗有利于 LTEC 患者的腹腔或锁骨上淋巴结受累和 UTEC 患者的腹腔淋巴结受累的 OS 和 CSS，而仅在 UTEC 患者的锁骨上淋巴结受累的情况下，放疗有利于 OS。
这些结果初步提供了证据，表明根据原发部位的不同预后信息，在胸段食管癌中，锁骨上和腹腔淋巴结转移的临床意义需要重新评估。
