Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY.
Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY.
J Thorac Cardiovasc Surg. 2022 Aug;164(2):411-419. doi: 10.1016/j.jtcvs.2021.11.094. Epub 2022 Mar 1.
Little is known about the pattern of nodal metastases in patients with esophageal adenocarcinoma who have received neoadjuvant chemoradiation and undergone surgery. We sought to assess this pattern and evaluate its association with prognosis.
All patients with esophageal adenocarcinoma who underwent neoadjuvant chemoradiation and R0 esophagectomy between 2010 and 2018 at our institution were included (n = 537). The primary objective was to evaluate the association of sites of lymph node metastases with disease-free survival. The number of nodal stations and individual sites of nodal metastases were evaluated first in univariable then in separate multivariable Cox regression models adjusted for clinical factors.
Of 537 patients, 193 (36%) had pathologic nodal metastases at the time of surgery; 153 (28%) had single-station disease, 32 (6.0%) had 2-station disease, and 8 (1.5%) had 3-station disease. The majority of patients with multiple positive nodal stations had positive nodes in the paraesophageal (93%) and/or left gastric stations (60%). Multivariable models controlling for clinical factors showed that an increasing number of positive nodal stations (hazard ratio, 1.59; 95% CI, 1.35-1.84; P < .01)-in particular, the subcarinal (hazard ratio, 2.78; 95% CI, 1.54-5.03; P < .01) and paraesophageal stations (hazard ratio, 2.0; 95% CI, 1.58-2.54; P < .01)-was associated with increased risk of recurrence.
One-third of patients who have undergone R0 resection for esophageal adenocarcinoma following induction chemoradiation therapy have metastatic lymph nodes. An increasing number of nodal stations, particularly paraesophageal and subcarinal metastases, were associated with increased risk of recurrence.
接受新辅助放化疗并接受手术的食管腺癌患者的淋巴结转移模式知之甚少。我们试图评估这种模式，并评估其与预后的关系。
本研究纳入了 2010 年至 2018 年期间在我院接受新辅助放化疗和 R0 食管切除术的所有食管腺癌患者（n=537）。主要目的是评估淋巴结转移部位与无病生存率的关系。首先在单变量中评估淋巴结转移部位与无病生存率的关系，然后在单独的多变量 Cox 回归模型中，根据临床因素进行调整。
537 例患者中，193 例（36%）在手术时存在病理淋巴结转移；153 例（28%）为单部位疾病，32 例（6.0%）为 2 部位疾病，8 例（1.5%）为 3 部位疾病。大多数有多个阳性淋巴结部位的患者，食管旁（93%）和/或胃左（60%）淋巴结阳性。多变量模型控制了临床因素，结果显示，阳性淋巴结部位数量的增加（风险比，1.59；95%置信区间，1.35-1.84；P<0.01）-特别是隆突下（风险比，2.78；95%置信区间，1.54-5.03；P<0.01）和食管旁（风险比，2.0；95%置信区间，1.58-2.54；P<0.01）与复发风险增加相关。
接受诱导放化疗后接受 R0 切除术的食管腺癌患者中，有三分之一的患者有转移性淋巴结。淋巴结部位数量的增加，特别是食管旁和隆突下转移，与复发风险增加相关。
