Wang Zhen, Lin Shaofeng, Wang Feng, Liu Shuoyan
Department of Thoracic Surgery, Fujian Cancer Hospital & Fujian Medical University Cancer Hospital, Fuzhou 350014, China.
Department of Thoracic Surgery, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China.
Ann Transl Med. 2019 Jun;7(11):238. doi: 10.21037/atm.2019.04.64.
Patients with thoracic esophageal squamous cell carcinoma (ESCC) often display recurrence in the cervical lymph nodes after surgery. The optimal treatment strategy for these patients has not been established. We retrospectively reviewed patients who underwent salvage lymphadenectomy plus adjuvant radiotherapy/chemotherapy for recurrence limited to the cervical lymph nodes to explore whether salvage treatment could provide an opportunity for curing these patients and to observe the prognostic factors for the patients after salvage treatment.
All patients with ESCC who underwent esophagectomy with lymphadenectomy and who were diagnosed with a relapse in the cervical nodes between 2007 to 2014. All cases received salvage lymphadenectomy plus adjuvant radiotherapy/chemotherapy. Their clinical characteristics and outcomes were analysed.
A total of 66 patients were diagnosed with recurrence in the cervical nodes after esophagectomy. Among these patients, 21 (31.8%) relapsed 6 months after esophagectomy and 45 (68.2%) recurrences were found 6 months later. Solitary cervical node recurrence was found in 31 (47.0%) patients while 35 (53.0%) cases showed multiple node relapse. Fifty-four (81.8%) patients underwent radical resection while 12 (18.2%) received reduction surgery. The univariate survival analysis showed that patients with solitary cervical node relapse had a better prognosis than patients with multiple node relapse (P=0.001). Patients who were diagnosed with a recurrence in 6 months after esophagectomy had worse outcomes than patients who relapsed 6 months later (P=0.007). Patients who underwent radical salvage lymphadenectomy had better survival than patients who underwent reduction dissection (P=0.004). The number of positive nodes at esophagectomy (3 or more/2 or less) and surgical treatment for recurrence (reduction/radical surgery) were found to have independent prognostic values by multivariate analysis, whereas the other two factors were not statistically significant.
Salvage cervical lymphadenectomy plus adjuvant radiotherapy/chemotherapy is an effective and safe treatment for ESCC patients who develop cervical lymph node recurrence after curative esophagectomy. A lower primary N stage and radical resection of recurrent nodes were found to have independent prognostic values for these patients.
胸段食管鳞状细胞癌（ESCC）患者术后常出现颈部淋巴结复发。这些患者的最佳治疗策略尚未确立。我们回顾性分析了因颈部淋巴结复发而接受挽救性淋巴结清扫术联合辅助放疗/化疗的患者，以探讨挽救性治疗是否能为治愈这些患者提供机会，并观察挽救性治疗后患者的预后因素。
所有ESCC患者均接受了食管切除术及淋巴结清扫术，并于2007年至2014年间被诊断为颈部淋巴结复发。所有病例均接受了挽救性淋巴结清扫术联合辅助放疗/化疗。分析了他们的临床特征和治疗结果。
共有66例患者在食管切除术后被诊断为颈部淋巴结复发。其中，21例（31.8%）在食管切除术后6个月内复发，45例（68.2%）在6个月后复发。31例（47.0%）患者为孤立性颈部淋巴结复发，35例（53.0%）为多组淋巴结复发。54例（81.8%）患者接受了根治性切除，12例（18.2%）接受了减瘤手术。单因素生存分析显示，孤立性颈部淋巴结复发患者的预后优于多组淋巴结复发患者（P = 0.001）。食管切除术后6个月内复发的患者预后较6个月后复发的患者差（P = 0.007）。接受根治性挽救性淋巴结清扫术的患者生存率高于接受减瘤手术的患者（P = 0.004）。多因素分析发现，食管切除时阳性淋巴结数量（3个或更多/2个或更少）及复发后的手术治疗方式（减瘤/根治性手术）具有独立的预后价值，而其他两个因素无统计学意义。
挽救性颈部淋巴结清扫术联合辅助放疗/化疗是根治性食管切除术后出现颈部淋巴结复发的ESCC患者的一种有效且安全的治疗方法。较低的原发N分期及复发病灶的根治性切除对这些患者具有独立的预后价值。
