Department of Thoracic, Endocrine Surgery and Oncology, Institute of Biomedical Sciences, Tokushima University Graduate School, Tokushima, Japan
Department of Thoracic, Endocrine Surgery and Oncology, Institute of Biomedical Sciences, Tokushima University Graduate School, Tokushima, Japan.
Anticancer Res. 2022 Jan;42(1):195-203. doi: 10.21873/anticanres.15473.
Histopathological tumor regression grade is applied not to lymph nodes but primary tumors modified by preoperative treatments. This study focused on patients whose pathological examination at the time of surgery showed no residual tumor after chemo(radio)therapy in the primary lesion (ypT0) or lymph nodes (ypN0).
A total of 87 patients with clinical stage II/III thoracic esophageal cancer underwent esophagectomy following preoperative treatments to evaluate significances between pathological response and clinical outcomes; 51 patients with clinically definitive lymph node metastasis (cN+) were analyzed as a subgroup.
ypT0 rates were 20.7% and 23.5%, and ypN0 rates were 47.1% and 27.5% in the whole cohort and in the cN+ subgroup, respectively. Disease-free survival, from surgery to relapse or death, was significantly influenced by ypN status (p=0.035) but not by ypT status in the 51 patients with definitive cN+ disease. Preoperative chemoradiation was an independent favorable factor for achievement of ypN0 in the 51 patients (odds ratio=0.09; p=0.007).
ypN status was a predictive factor for DFS in patients treated with docetaxel plus low-dose 5-fluorouracil and cisplatin combined chemotherapy, superior to ypT status, especially in patients with definitive cN+ disease.
肿瘤组织学消退分级并非应用于淋巴结，而是应用于经术前治疗的原发肿瘤。本研究聚焦于手术时病理检查原发肿瘤（ypT0）或淋巴结（ypN0）中无残留肿瘤的患者。
共 87 例临床 II/III 期胸段食管鳞癌患者接受了术前治疗后的食管癌切除术，以评估病理反应与临床结局之间的关系；51 例临床明确的淋巴结转移（cN+）患者被作为亚组进行分析。
全队列和 cN+亚组的 ypT0 率分别为 20.7%和 23.5%，ypN0 率分别为 47.1%和 27.5%。无复发生存期，即从手术到复发或死亡的时间，在 51 例明确 cN+疾病患者中受 ypN 状态影响（p=0.035），但不受 ypT 状态影响。在 51 例患者中，术前放化疗是实现 ypN0 的独立有利因素（优势比=0.09；p=0.007）。
在接受多西紫杉醇联合低剂量氟尿嘧啶和顺铂联合化疗的患者中，ypN 状态是 DFS 的预测因素，优于 ypT 状态，特别是在明确 cN+疾病的患者中。
