胸段食管鳞状细胞癌右侧喉返神经淋巴结的临床评估

Clinical evaluation of right recurrent laryngeal nerve nodes in thoracic esophageal squamous cell carcinoma.

作者信息

Li Zhen-Xuan, Li Xiao-Dong, Liu Xian-Ben, Xing Wen-Qun, Sun Hai-Bo, Wang Zong-Fei, Zhang Rui-Xiang, Li Yin

机构信息

Department of Thoracic Surgery, The Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou, China.

Department of Thoracic Surgery, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Guangzhou, China.

出版信息

J Thorac Dis. 2020 Jul;12(7):3622-3630. doi: 10.21037/jtd-20-774.

DOI:10.21037/jtd-20-774

PMID:32802441

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC7399419/

Abstract

BACKGROUND

The accuracy of clinical N staging of esophageal squamous cell carcinoma is suboptimal. As an important station of lymph node metastasis, station C201 (right recurrent laryngeal nerve nodes) has rarely been evaluated alone. We aimed to explore an effective way to evaluate the right recurrent laryngeal nerve nodes in thoracic esophageal squamous cell carcinoma.

METHODS

We retrospectively analyzed 628 thoracic esophageal squamous cell carcinoma patients who underwent radical resection without neoadjuvant therapy from two Chinese cancer centers. The diameter of the short axis of the largest right recurrent laryngeal nerve node (DC201) was measured on contrast-enhanced multi-slice computed tomography (MSCT). Right recurrent laryngeal nerve nodes were examined by postoperative pathologic results. The receiver operating characteristic (ROC) curve was generated to assess the diagnostic capabilities of DC201 to determine the right recurrent laryngeal nerve nodes status.

RESULTS

ROC curve analysis revealed that the optimal cut-off point of DC201 was 6 mm, with an area under curve (AUC), sensitivity, specificity, and Youden index of 0.896, 71.9%, 88.8%, and 0.607 respectively. When the cut-off point of DC201 was set to 10 mm, sensitivity, specificity and the Youden index were 14.1%, 99.6% and 0.137 respectively. Among 128 patients with right recurrent laryngeal nerve node metastasis, 71 and 108 patients had the largest right recurrent laryngeal nerve node located above the suprasternal notch level and in the tracheoesophageal groove respectively.

CONCLUSIONS

When DC201 ≥6.0 mm instead of DC201 ≥10 mm was used to dictate the right recurrent laryngeal nerve nodes metastasis, contrast-enhanced MSCT could evaluate the status of right recurrent laryngeal nerve nodes with high sensitivity and specificity. The largest right recurrent laryngeal nerve nodes were mainly located in the tracheoesophageal groove and/or above the suprasternal notch.

摘要

背景

食管鳞状细胞癌临床N分期的准确性欠佳。作为淋巴结转移的一个重要部位，C201站（右侧喉返神经淋巴结）很少单独进行评估。我们旨在探索一种评估胸段食管鳞状细胞癌右侧喉返神经淋巴结的有效方法。

方法

我们回顾性分析了来自两个中国癌症中心的628例接受了根治性切除且未接受新辅助治疗的胸段食管鳞状细胞癌患者。在对比增强多层计算机断层扫描（MSCT）上测量最大右侧喉返神经淋巴结的短轴直径（DC201）。通过术后病理结果检查右侧喉返神经淋巴结。绘制受试者工作特征（ROC）曲线以评估DC201判断右侧喉返神经淋巴结状态的诊断能力。

结果

ROC曲线分析显示，DC201的最佳截断点为6mm，曲线下面积（AUC）、敏感性、特异性和尤登指数分别为0.896、71.9%、88.8%和0.607。当DC201的截断点设定为10mm时，敏感性、特异性和尤登指数分别为14.1%、99.6%和0.137。在128例右侧喉返神经淋巴结转移患者中，最大右侧喉返神经淋巴结分别位于胸骨上切迹水平上方和气管食管沟的患者有71例和108例。