Yu Yongkui, Xu Lei, Chen Xiankai, Li Haomiao, Liu Qi, Zhang Ruixiang, Xie Hounai, Chen Yongfeng, Yuan Ling, Tan Bo, Li Yin, Xing Wenqun
Department of Thoracic Surgery, The Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou, China.
Department of Thoracic Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
Ann Transl Med. 2022 Mar;10(6):349. doi: 10.21037/atm-22-577.
Multiple clinical trials were conducted to evaluate the efficacy of neoadjuvant therapy in esophageal cancer but exhibited mixed results, indicating that the efficacy of neoadjuvant therapy remains controversial in the treatment of esophageal cancer. Our study was conducted to investigate the value of neoadjuvant therapy in patients with esophageal cancer with supraclavicular lymph node metastases.
We retrospectively enrolled 231 patients who had resectable esophageal squamous cell carcinoma (ESCC) with supraclavicular lymph node metastases from June 2008 to November 2018. All patients were divided into three groups: the neoadjuvant therapy combined with surgery (Neo + S) group, the radical chemoradiotherapy (CRT) group, and the single radiotherapy (RT) group. Propensity score matching (PSM) was conducted to exclude the impact of potential interferences. Kaplan-Meier analysis, the log-rank test, and competitive risk model analysis were used to assess the efficacy of different therapeutic methods.
Patients in the Neo + S group had a better 3-year survival rate (72.0% 35.8%; P=0.005), progression-free survival (PFS) (24 14 months; P<0.0001), and lower 3-year tumor-specific mortality risk (25.1% 53.7%; P=0.005) than those in the CRT group. Furthermore, patients in the CRT group had a better 3-year survival (30.1% 18.6%; P=0.012) and lower 3-year tumor-specific mortality risk (57.9% 76.8%; P=0.011) than those in the RT group. Additionally, the supraclavicular lymph node metastasis rate was higher than the mediastinal lymph node metastasis rate in patients with upper esophageal cancer compared to middle and lower esophageal cancer.
Neoadjuvant chemotherapy combined with surgery showed better efficacy than radical CRT in patients who had resectable ESCC with supraclavicular lymph nodes metastasis. Supraclavicular lymph nodes are more likely to be regional lymph nodes for upper and middle esophageal cancer.
开展了多项临床试验以评估新辅助治疗在食管癌中的疗效，但结果不一，这表明新辅助治疗在食管癌治疗中的疗效仍存在争议。我们开展本研究旨在探讨新辅助治疗在伴有锁骨上淋巴结转移的食管癌患者中的价值。
我们回顾性纳入了2008年6月至2018年11月期间患有可切除食管鳞状细胞癌（ESCC）且伴有锁骨上淋巴结转移的231例患者。所有患者分为三组：新辅助治疗联合手术（Neo + S）组、根治性放化疗（CRT）组和单纯放疗（RT）组。进行倾向评分匹配（PSM）以排除潜在干扰因素的影响。采用Kaplan-Meier分析、对数秩检验和竞争风险模型分析来评估不同治疗方法的疗效。
与CRT组相比，Neo + S组患者的3年生存率更高（72.0% 对35.8%；P = 0.005），无进展生存期（PFS）更长（24个月对14个月；P < 0.0001），3年肿瘤特异性死亡风险更低（25.1% 对53.7%；P = 0.005）。此外，与RT组相比，CRT组患者的3年生存率更高（30.1% 对18.6%；P = 0.012），3年肿瘤特异性死亡风险更低（57.9% 对76.8%；P = 0.011）。此外，与中下段食管癌相比，上段食管癌患者的锁骨上淋巴结转移率高于纵隔淋巴结转移率。
对于伴有锁骨上淋巴结转移的可切除ESCC患者，新辅助化疗联合手术显示出比根治性CRT更好的疗效。锁骨上淋巴结更有可能是上段和中段食管癌的区域淋巴结。
