Dai Liang, Yang Yong-Bo, Wu Ya-Ya, Fu Hao, Yan Wan-Pu, Lin Yao, Wang Zi-Ming, Chen Ke-Neng
Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), The First Department of Thoracic Surgery, Peking University Cancer Hospital and Institute, Peking University School of Oncology, Beijing, China.
Front Surg. 2023 Jan 6;9:1043755. doi: 10.3389/fsurg.2022.1043755. eCollection 2022.
Even underwent radical resection, some patients of thoracic esophageal squamous cell carcinoma (ESCC) are still exposed to local recurrence in a short time. To this end, the present study sought to differentiate patient subgroups by assessing risk factors for postoperative early (within one year) local lymph node recurrence (PELLNR).
ESCC patients were selected from a prospective database, and divided into high- and low-risk groups according to the time of their local lymphatic recurrence (within one year or later). Survival analysis was conducted by the Cox regression model to evaluate the overall survival (OS) between the two groups. The hazard ratio (HR) and 95% confidence interval (CI) of different variables were also calculated. Logistic regression analysis was used to explore the high-risk factors for PELLNR with the odds ratio (OR) and 95% CI calculated.
A total of 432 cases were included. The survival of patients in the high-risk group ( = 47) was significantly inferior to the low-risk group ( = 385) (HR = 11.331, 95% CI: 6.870-16.688, < 0.001). The 1-year, 3-year, and 5-year OS rate of the patients in high/low-risk groups were 74.5% vs. 100%, 17% vs. 88.8%, and 11.3% vs. 79.2%, respectively ( < 0.001). Risk factors for local lymph node recurrence within one year included upper thoracic location (OR = 4.071, 95% CI: 1.499-11.055, = 0.006), advanced T staging (pT3-4, OR = 3.258, 95% CI: 1.547-6.861, = 0.002), advanced N staging (pN2-3, OR = 5.195, 95% CI: 2.269-11.894, < 0.001), and neoadjuvant treatment (OR = 3.609, 95% CI: 1.716-7.589, = 0.001). In neoadjuvant therapy subgroup, high-risk group still had unfavorable survival (Log-rank < 0.001). Multivariate analysis demonstrated that upper thoracic location (OR = 5.064, 95% CI: 1.485-17.261, = 0.010) and advanced N staging (pN2-3) (OR = 5.999, 95% CI: 1.986-18.115, = 0.001) were independent risk factors for early local lymphatic recurrence. However, the cT downstaging (OR = 0.862, 95% CI: 0.241-3.086, = 0.819) and cN downstaging (OR = 0.937, 95% CI: 0.372-2.360, = 0.890) for patients in the neoadjuvant subgroup failed to lower PELLNR. The predominant recurrence field type was single-field.
Thoracic ESCC patients with lymph node recurrence within one year delivered poor outcomes, with advanced stages (pT3-4/pN2-3) and upper thoracic location considered risk factors for early recurrence.
部分胸段食管鳞状细胞癌（ESCC）患者即便接受了根治性切除，仍会在短时间内出现局部复发。为此，本研究旨在通过评估术后早期（1年内）局部淋巴结复发（PELLNR）的危险因素来区分患者亚组。
从一个前瞻性数据库中选取ESCC患者，并根据其局部淋巴复发时间（1年内或之后）分为高风险组和低风险组。采用Cox回归模型进行生存分析，以评估两组之间的总生存期（OS）。还计算了不同变量的风险比（HR）和95%置信区间（CI）。使用逻辑回归分析来探索PELLNR的高危因素，并计算比值比（OR）和95%CI。
共纳入432例病例。高风险组（n = 47）患者的生存率显著低于低风险组（n = 385）（HR = 11.331，95%CI：6.870 - 16.688，P < 0.001）。高/低风险组患者的1年、3年和5年OS率分别为74.5%对100%、17%对88.8%、11.3%对79.2%（P < 0.001）。1年内局部淋巴结复发的危险因素包括胸段上部位置（OR = 4.071，95%CI：1.499 - 11.055，P = 0.006）、T分期晚期（pT3 - 4，OR = 3.258，95%CI：1.547 - 6.861，P = 0.002）、N分期晚期（pN2 - 3，OR = 5.195，95%CI：2.269 - 11.894，P < 0.001）和新辅助治疗（OR = 3.609，95%CI：1.716 - 7.589，P = 0.001）。在新辅助治疗亚组中，高风险组的生存情况仍然不佳（Log - rank P < 0.001）。多因素分析表明，胸段上部位置（OR = 5.064，95%CI：1.485 - 17.261，P = 0.010）和N分期晚期（pN2 - 3）（OR = 5.999，95%CI：1.986 - 18.115，P = 0.001）是早期局部淋巴复发的独立危险因素。然而，新辅助亚组患者的cT降期（OR = 0.862，95%CI：0.241 - 3.086，P = 0.819）和cN降期（OR =
