ypN0 在术前治疗后明确 cN 阳性状态的食管癌患者中是一个预后因素。

ypN0 in Patients With Definitive cN-positive Status After Preoperative Treatment Is a Prognostic Factor in Esophageal Cancer.

机构信息

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.

出版信息

Anticancer Res. 2022 Jan;42(1):195-203. doi: 10.21873/anticanres.15473.

DOI:10.21873/anticanres.15473

PMID:34969725

Abstract

BACKGROUND

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).

PATIENTS AND METHODS

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.

RESULTS

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).

CONCLUSION

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.

摘要

背景

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。

患者和方法

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。

结果

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）。