Department of Thoracic Surgery, Med+X Center for Informatics, West China Hospital, Sichuan University, Chengdu, China.
Biomedical Big Data Center of West China Hospital, Med+X Center for Informatics, Sichuan University, Chengdu, China.
Ann Thorac Surg. 2023 Jun;115(6):1386-1394. doi: 10.1016/j.athoracsur.2022.07.052. Epub 2022 Aug 23.
Lymphovascular invasion and perineural invasion are unfavorable prognostic factors in patients with esophageal squamous cell carcinoma. However, the prevalence and prognostic importance of lymphovascular invasion and perineural invasion after neoadjuvant chemoradiotherapy in these patients remains unclear.
We retrospectively reviewed specimens of 321 patients with pathologically diagnosed esophageal squamous cell carcinoma who underwent neoadjuvant chemoradiotherapy in our institution from 2017 to 2020. Lymphovascular invasion and perineural invasion were assessed by hematoxylin and eosin staining. Survival was analyzed using the log-rank test and multivariable Cox regression analysis.
Lymphovascular invasion and perineural invasion were present in 12.5% (n = 40) and 17.8% (n = 57) of resection specimens, respectively. Lymphovascular invasion and perineural invasion were significantly more common in patients with advanced cancer (both P < .05). In the univariate analyses, lymphovascular invasion and perineural invasion were associated with shorter overall survival and disease-free survival. Multivariable analysis revealed that lymphovascular invasion after neoadjuvant therapy was an independent adverse prognostic factor for overall survival and disease-free survival. Subgroup analyses showed that lymphovascular invasion could identify cases with worse overall survival or disease-free survival among node-negative patients, indicating the role of lymphovascular invasion in the precise staging of pN0 patients.
Lymphovascular invasion and perineural invasion were significantly negatively correlated with overall survival and disease-free survival. Lymphovascular invasion was an independent prognostic predictor in esophageal squamous cell carcinoma patients after neoadjuvant chemoradiotherapy. Lymphovascular invasion and perineural invasion should be considered in the histopathology workup for esophageal squamous cell carcinoma patients after neoadjuvant chemoradiotherapy.
淋巴血管侵犯和神经周围侵犯是食管鳞癌患者的不良预后因素。然而，这些患者在新辅助放化疗后出现淋巴血管侵犯和神经周围侵犯的流行率及其预后意义仍不清楚。
我们回顾性分析了 2017 年至 2020 年在我院接受新辅助放化疗的 321 例病理诊断为食管鳞癌患者的标本。通过苏木精和伊红染色评估淋巴血管侵犯和神经周围侵犯。采用对数秩检验和多变量 Cox 回归分析进行生存分析。
在切除标本中，分别有 12.5%（n=40）和 17.8%（n=57）存在淋巴血管侵犯和神经周围侵犯。晚期癌症患者中，淋巴血管侵犯和神经周围侵犯更为常见（均 P<.05）。单因素分析显示，淋巴血管侵犯和神经周围侵犯与总生存期和无病生存期较短相关。多变量分析显示，新辅助治疗后的淋巴血管侵犯是总生存期和无病生存期的独立不良预后因素。亚组分析表明，淋巴血管侵犯可在淋巴结阴性患者中识别出总生存期或无病生存期较差的病例，表明淋巴血管侵犯在 pN0 患者的精确分期中具有作用。
淋巴血管侵犯和神经周围侵犯与总生存期和无病生存期显著负相关。淋巴血管侵犯是新辅助放化疗后食管鳞癌患者的独立预后预测因素。对于新辅助放化疗后的食管鳞癌患者，应在组织病理学检查中考虑淋巴血管侵犯和神经周围侵犯。
