Department of Gastroenterological Surgery (Surgery II), Nagoya University Graduate School of Medicine, Nagoya, Japan.
Department of Innovative Research and Education for Clinicians and Trainees (DiRECT), Fukushima Medical University Hospital, Fukushima, Japan.
Ann Surg Oncol. 2020 Sep;27(9):3195-3205. doi: 10.1245/s10434-020-08433-6. Epub 2020 Apr 3.
Recurrence after radical resection of esophageal squamous cell carcinoma (ESCC) is common. Limited evidence is available about the differences in clinical characteristics, risk factors, and prognostic significance between nodal and distant recurrence of thoracic ESCC.
We retrospectively analyzed 341 patients who underwent radical resection of thoracic ESCC and experienced (1) initial recurrence only in lymph nodes (n = 39), (2) recurrence only at distant organs (n = 57), or (3) no recurrences (n = 245) after follow-up ≥ 24 months. Clinicopathological characteristics, survival times, and risk factors were compared between the nodal and distant recurrence groups.
The median follow-up time was 57.8 months. Metastasectomy as initial treatment for the recurrence was performed for six (15.4%) patients in the nodal recurrence group and one patient in the distant recurrence group. Compared with the nodal recurrence group, patients with distant recurrence had significantly shorter disease-free survival [hazard ratio (HR) 1.68, 95% confidence interval (CI) 1.10-2.57, P = 0.0169], postrecurrence survival (HR 1.77, 95% CI 1.01-3.10, P = 0.0476), and overall survival (HR 1.98, 95% CI 1.12-3.51, P = 0.0193). The distant recurrence group had significantly larger macroscopic tumor size and more advanced pathological T stage than the nodal recurrence group, whereas preoperative treatment, tumor location, number of fields dissected, tumor differentiation, lymphatic involvement, and vessel invasion were not significantly different between the two groups.
Survival times and recurrence risk factors differed between patients with nodal and distant recurrence after radical resection of thoracic ESCC.
食管鳞癌（ESCC）根治性切除术后复发较为常见。目前关于胸段 ESCC 淋巴结和远处复发的临床特征、危险因素和预后意义的差异，仅有有限的证据。
我们回顾性分析了 341 例接受胸段 ESCC 根治性切除术且随访时间≥24 个月的患者，其中（1）仅淋巴结初始复发（n=39），（2）仅远处器官复发（n=57），或（3）无复发（n=245）。比较了淋巴结和远处复发组的临床病理特征、生存时间和危险因素。
中位随访时间为 57.8 个月。淋巴结复发组中有 6 例（15.4%）患者接受了转移灶切除术作为复发的初始治疗，而远处复发组仅 1 例。与淋巴结复发组相比，远处复发组患者的无疾病生存率[风险比（HR）1.68，95%置信区间（CI）1.10-2.57，P=0.0169]、复发后生存率（HR 1.77，95%CI 1.01-3.10，P=0.0476）和总生存率（HR 1.98，95%CI 1.12-3.51，P=0.0193）明显更短。远处复发组的肿瘤宏观大小明显大于淋巴结复发组，且病理 T 分期更晚，而术前治疗、肿瘤位置、清扫的淋巴结组数、肿瘤分化程度、淋巴管浸润和脉管侵犯在两组间无显著差异。
胸段 ESCC 根治性切除术后淋巴结和远处复发患者的生存时间和复发危险因素不同。
