Department of Surgery, China Medical University Hospital, Taichung, Taiwan.
School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan.
World J Surg. 2020 Jul;44(7):2323-2331. doi: 10.1007/s00268-020-05481-7.
For advanced esophageal cancer, the clinical significance of pretreatment nodal status (cN) as determined by different examinations remains unclear.
Patients with esophageal squamous cell carcinoma who underwent neoadjuvant chemoradiation and surgery were analyzed in this study. Pretreatment cN status assessed by CT, EUS, and PET/CT and clinicopathological features were used to evaluate tumor recurrence and long-term survival.
Two hundred and twenty-two patients were identified in this study. Pretreatment PET/CT cN0 [odds ratio (OR) cN0 versus cN+, 5.316, p < 0.001] and pretreatment CT cN0 (OR 1.957, p = 0.032) both independently predicted ypN0. Pretreatment PET/CT cN0 was also associated with a lower recurrence rate and longer survival across the entire study group. Among patients with ypN0, pretreatment PET/CT cN+ indicated poor disease-free survival [hazard ratio (HR) 2.777, p = 0.001] and overall survival (HR 2.211, p = 0.034) compared with pretreatment PET/CT cN0, which predicted a favorable prognosis.
Data from the current study suggest that pretreatment lymph node status as assessed by PET/CT is strongly correlated with survival outcomes after neoadjuvant chemoradiation and surgery in patients with esophageal squamous cell carcinoma. ypN0 patients can achieve better survival outcomes when pretreatment cN0 is assessed by PET/CT.
对于晚期食管癌，不同检查方法确定的治疗前淋巴结状态（cN）的临床意义尚不清楚。
本研究分析了接受新辅助放化疗和手术的食管鳞癌患者。使用治疗前 CT、EUS 和 PET/CT 评估的 cN 状态和临床病理特征来评估肿瘤复发和长期生存情况。
本研究共纳入 222 例患者。治疗前 PET/CT cN0（比值比 cN0 与 cN+，5.316，p<0.001）和治疗前 CT cN0（比值比 1.957，p=0.032）均独立预测 ypN0。治疗前 PET/CT cN0 还与整个研究组更低的复发率和更长的生存时间相关。在 ypN0 患者中，治疗前 PET/CT cN+预示着无病生存（风险比 2.777，p=0.001）和总生存（风险比 2.211，p=0.034）不良，而治疗前 PET/CT cN0 则预示着预后良好。
本研究数据表明，治疗前 PET/CT 评估的淋巴结状态与食管鳞癌患者新辅助放化疗和手术后的生存结局密切相关。当治疗前 cN0 由 PET/CT 评估时，ypN0 患者可获得更好的生存结局。
