Department of Surgery, Amsterdam UMC, University of Amsterdam, Cancer Center Amsterdam, Amsterdam, the Netherlands.
Department of Surgery and Cancer, Imperial College London, London, UK.
Dis Esophagus. 2022 Jan 7;35(1). doi: 10.1093/dote/doab021.
The prognostic value of histomorphologic regression in primary esophageal cancer has been previously established, however the impact of lymph node (LN) response on survival still remains unclear. The aim of this review was to assess the prognostic significance of LN regression or downstaging following neoadjuvant therapy for esophageal cancer.
An electronic search was performed to identify articles evaluating LN regression or downstaging after neoadjuvant therapy. Random effects meta-analyses were performed to assess the influence of regression in the LNs and nodal downstaging on overall survival. Histomorphologic tumor regression in LNs was defined by the absence of viable cells or degree of fibrosis on histopathologic examination. Downstaged LNs were defined as pN0 nodes by the tumor, node, and metastasis classification, which were positive prior to treatment neoadjuvant.
Eight articles were included, three of which assessed tumor regression (number of patients = 292) and five assessed downstaging (number of patients = 1368). Complete tumor regression (average rate of 29.1%) in the LNs was associated with improved survival, although not statistically significant (hazard ratio [HR] = 0.52, 95% confidence interval [CI] = 0.26-1.06; P = 0.17). LNs downstaging (average rate of 32.2%) was associated with improved survival compared to node positivity after neoadjuvant treatment (HR = 0.41, 95%CI = 0.22-0.77; P = 0.005).
The findings of this meta-analysis have shown a survival benefit in patients with LN downstaging and are suggestive for considering LN downstaging to ypN0 as an additional prognostic marker in staging and in the comparative evaluation of differing neoadjuvant regimens in clinical trials. No statistically significant effect of histopathologic regression in the LNs on long-term survival was seen.
原发性食管癌的组织形态学消退的预后价值已得到证实，但淋巴结（LN）反应对生存的影响仍不清楚。本综述的目的是评估新辅助治疗后食管癌 LN 消退或降级对生存的预测意义。
进行了电子检索，以确定评估新辅助治疗后 LN 消退或降级的文章。采用随机效应荟萃分析评估 LN 消退或降级对总生存的影响。组织形态学 LN 肿瘤消退定义为组织病理学检查无存活细胞或纤维化程度。降期 LN 定义为肿瘤、淋巴结和转移分类中的 pN0 节点，这些节点在治疗前新辅助治疗时为阳性。
共纳入 8 篇文章，其中 3 篇评估肿瘤消退（患者人数=292），5 篇评估降级（患者人数=1368）。LN 完全消退（平均消退率为 29.1%）与生存改善相关，但无统计学意义（风险比[HR] = 0.52，95%置信区间[CI] = 0.26-1.06；P=0.17）。与新辅助治疗后 LN 阳性相比，LN 降级（平均降级率为 32.2%）与生存改善相关（HR = 0.41，95%CI = 0.22-0.77；P=0.005）。
本荟萃分析的结果表明 LN 降级患者的生存获益，提示考虑将 LN 降级为 ypN0 作为分期的附加预后标志物，并在临床试验中对不同新辅助方案进行比较评估。未观察到 LN 组织形态学消退对长期生存的统计学显著影响。
