Department of Surgery, University Medical Center Utrecht, Utrecht University, Heidelberglaan 100, P.O. Box 85500, 3508 GA, Utrecht, the Netherlands; Department of Anatomy, University Medical Center Utrecht, Utrecht University, Universiteitsweg 100, P.O Box 85060, 3508 AB, Utrecht, the Netherlands.
Department of Surgery, University Medical Center Utrecht, Utrecht University, Heidelberglaan 100, P.O. Box 85500, 3508 GA, Utrecht, the Netherlands.
Surg Oncol. 2020 Jun;33:170-176. doi: 10.1016/j.suronc.2020.02.012. Epub 2020 Feb 15.
Extra-regional lymph node metastases strongly determine treatment options in patients with esophageal cancer. Staging modalities such as (FDG-PET) CT scanning frequently show activity in retroperitoneal and lung hilar lymph nodes. This study evaluated the incidence of histologically confirmed metastases, treatment approach and recurrence patterns in patients with (FDG-PET) CT positivity in these regions.
All patients with (FDG-PET-) CT positive hilar and/or retroperitoneal lymph nodes at primary staging or restaging discussed at a multidisciplinary tumor board meeting for staging of esophageal cancer between January 2012-December 2017 were included. Biopsies and follow-up were evaluated to determine the presence of metastases and progression rates.
From 2012 to 2017, 65 of 857 patients (7.6%) were selected with positive retroperitoneal and/or hilar lymph nodes. A total of 47/65 (72.3%) patients had positive retroperitoneal lymph nodes, which contained metastases in 19 (29.2%). When no biopsy was performed and curative treatment was given (n = 14), 9 patients had progression or locoregional and distant recurrence. Positive hilar lymph nodes were identified in 21 (32.3%) patients; 4 were biopsied and none contained metastases. In these patients no recurrence of disease was seen during follow-up.
The majority of biopsied (PET)CT-positive retroperitoneal lymph nodes at staging contained metastases, while biopsied (PET)CT-positive hilar nodes did not. Histological evaluation of (PET)CT -positive retroperitoneal lymph nodes at staging imaging is recommended, while based on this small series, (PET)CT-positive hilar lymph nodes most likely represent reactive lymphadenopathy.
食管外淋巴结转移强烈决定了食管癌患者的治疗选择。分期方法，如（FDG-PET）CT 扫描，经常显示腹膜后和肺门淋巴结有活性。本研究评估了在这些区域（FDG-PET）CT 阳性的患者中，经组织学证实的转移、治疗方法和复发模式的发生率。
所有在 2012 年 1 月至 2017 年 12 月期间在多学科肿瘤委员会会议上讨论的原发性分期或再分期时（FDG-PET）CT 阳性的食管旁和/或肺门淋巴结的患者都被纳入本研究。评估活检和随访结果以确定是否存在转移和进展率。
从 2012 年到 2017 年，65 例 857 例患者（7.6%）在（FDG-PET）CT 检查中发现腹膜后和/或肺门淋巴结阳性。47/65 例（72.3%）患者有阳性腹膜后淋巴结，其中 19 例（29.2%）有转移。当未进行活检且给予根治性治疗（n=14）时，9 例患者出现进展或局部和远处复发。21 例（32.3%）患者的肺门淋巴结阳性；其中 4 例进行了活检，均无转移。在这些患者中，随访期间未发现疾病复发。
分期时（PET）CT 阳性腹膜后淋巴结活检的大多数含有转移，而（PET）CT 阳性肺门淋巴结活检的则没有。建议对分期影像学检查（PET）CT 阳性腹膜后淋巴结进行组织学评估，而基于这一小系列研究，（PET）CT 阳性肺门淋巴结很可能代表反应性淋巴结病。
