未切除的小淋巴结评估可预测 pT3N0M0 胸段食管鳞癌患者的预后。
Unresected small lymph node assessment predicts prognosis for patients with pT3N0M0 thoracic esophageal squamous cell carcinoma.
机构信息
Department of Radiation Oncology, Sichuan Cancer Hospital and Institution, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Radiation Oncology Key Laboratory of Sichuan Province, No.55,Section 4,South Renmin Road, Chengdu, 610042, China.
Department of Medical Oncology, Sichuan Cancer Hospital and Institution, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China.
出版信息
World J Surg Oncol. 2021 Oct 18;19(1):303. doi: 10.1186/s12957-021-02412-1.
BACKGROUND
The role of unresected small lymph nodes (LNs) which may contain metastases for thoracic esophageal squamous cell carcinoma (TESCC) has not been addressed. The aim of the study was to investigate the role of unresected small LNs assessment using computed tomography (CT) in prognostic estimates of pT3N0M0 TESCC patients.
METHODS
Between January 2009 and December 2017, 294 patients who underwent esophagectomy with R0 resection at Sichuan Cancer Hospital were retrospectively examined, and the last follow-up time was July 2018. Patients were classified into CT-suspect and CT-negative groups according to the shortest diameter and the shape (axial ratio) of the unresected small LNs on preoperative CT. The Kaplan-Meier method was used to compare survival differences in prognostic factors. Univariate and multivariate analyses were performed to identify prognostic factors for survival and recurrence.
RESULTS
Eighty-four patients (28.6%) were classified as CT-suspect group according to the diagnostic criteria; survival analysis suggested that CT-suspect group of patients had a relatively poorer prognosis (P<0.05). Cox regression analysis indicated that unresected small LNs status, tumor grade, and postoperative adjuvant therapy were independent prognostic factors for patients with pT3N0M0 TESCC (P<0.05). Further analysis shown the rates of total recurrence (TR) and locoregional recurrence (LR) in the CT-suspect group were significantly higher than that in the CT-negative group (TR, P<0.001; LR, P<0.001). Among the LRs, the rate of supraclavicular lymph node recurrence in the CT-suspect group was significantly higher than that in the CT-negative group (P<0.001).
CONCLUSIONS
Unresected small lymph node assessment is critically important and predict prognosis for pT3N0M0 TESCC patients.
背景
未切除的小淋巴结（LNs）可能包含胸段食管鳞癌（TESCC）的转移，但尚未确定其作用。本研究旨在探讨使用计算机断层扫描（CT）评估未切除的小 LNs 在 pT3N0M0 TESCC 患者预后估计中的作用。
方法
回顾性分析 2009 年 1 月至 2017 年 12 月在四川省肿瘤医院接受 R0 切除食管切除术的 294 例患者的资料，末次随访时间为 2018 年 7 月。根据术前 CT 上未切除的小 LNs 的最短直径和形状（轴向比），将患者分为 CT 可疑组和 CT 阴性组。采用 Kaplan-Meier 法比较预后因素的生存差异。进行单因素和多因素分析以确定生存和复发的预后因素。
结果
根据诊断标准，84 例患者（28.6%）被归类为 CT 可疑组；生存分析表明 CT 可疑组患者的预后相对较差（P<0.05）。Cox 回归分析表明，未切除的小 LNs 状态、肿瘤分级和术后辅助治疗是 pT3N0M0 TESCC 患者的独立预后因素（P<0.05）。进一步分析表明，CT 可疑组的总复发（TR）和局部区域复发（LR）率明显高于 CT 阴性组（TR，P<0.001；LR，P<0.001）。在 LRs 中，CT 可疑组锁骨上淋巴结复发率明显高于 CT 阴性组（P<0.001）。
结论
未切除的小淋巴结评估对于 pT3N0M0 TESCC 患者非常重要，可以预测预后。
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