微创食管癌切除术中上纵隔淋巴结清扫对鳞状细胞癌预后的改善效果：疗效指标及倾向评分匹配分析

Improvement Effect of Upper Mediastinal Lymphadenectomy During Minimally Invasive Esophagectomy on the Prognosis in Squamous Cell Carcinoma: Efficacy Index and Propensity Score Matching Analyses.

作者信息

Oshikiri Taro, Goto Hironobu, Kato Takashi, Hasegawa Hiroshi, Kanaji Shingo, Yamashita Kimihiro, Fujino Yasuhiro, Tominaga Masahiro, Matsuda Takeru, Kakeji Yoshihiro

机构信息

From the Divisions of Gastrointestinal Surgery (Oshikiri, Goto, Kato, Hasegawa, Kanaji, Yamashita, Kakeji), Department of Surgery, Graduate School of Medicine, Kobe University, Hyogo, Japan.

Department of Gastroenterological Surgery (Fujino, Tominaga), Hyogo Cancer Center, Hyogo, Japan.

出版信息

J Am Coll Surg. 2023 Nov 1;237(5):762-770. doi: 10.1097/XCS.0000000000000794. Epub 2023 Jun 27.

DOI:10.1097/XCS.0000000000000794

PMID:37366544

Abstract

BACKGROUND

The effect of lymphadenectomy around the recurrent laryngeal nerve (RLN) in open esophagectomy has been demonstrated with the efficacy index (EI). However, it remains unclear whether this effect exists for minimally invasive esophagectomy (MIE) in the prone position. The purpose of this study was to clarify whether the upper mediastinal lymphadenectomy contributed to improved prognosis in patients with esophageal squamous cell carcinoma.

STUDY DESIGN

This study included 339 patients with esophageal squamous cell carcinoma treated with MIE in the prone position at Kobe University or Hyogo Cancer Center, Japan, from 2010 to 2015. EIs for each station, correlations between metastatic lymph nodes around the left RLN and RLN palsy, and survival of patients with and without upper mediastinal lymphadenectomy were investigated.

RESULTS

Among 297 patients treated with upper mediastinal lymphadenectomy, Clavien- Dindo grade ≥ II left RLN palsy occurred in 59 patients (20%). Overall, EIs for the right RLN (7.4) and left RLN (6.6) were higher than EIs for other stations. For patients with upper-third or middle-third tumors, the trend was stronger. Left RLN palsy was more likely in patients with metastatic lymph nodes around the left RLN than in those without (44% vs 15%, p < 0.0001). After propensity score-matching, 42 patients were included in each group with and without upper mediastinal lymphadenectomy. In survival analyses, the 5-year overall survival rates were 55% vs 35% and cause-specific survival rates were 61% vs 43% for the patients with and without upper mediastinal lymphadenectomy respectively. Significant differences were confirmed in survival curves (overall survival: p = 0.03; cause-specific survival: p = 0.04, respectively).

CONCLUSIONS

Upper mediastinal lymphadenectomy contributes to improved prognosis with high EIs in MIE in the prone position.

摘要

背景

开放性食管切除术中，喉返神经（RLN）周围淋巴结清扫的效果已通过疗效指数（EI）得到证实。然而，对于俯卧位微创食管切除术（MIE），这种效果是否存在仍不清楚。本研究的目的是明确上纵隔淋巴结清扫是否有助于改善食管鳞状细胞癌患者的预后。

研究设计

本研究纳入了2010年至2015年在日本神户大学或兵库癌症中心接受俯卧位MIE治疗的339例食管鳞状细胞癌患者。研究了各站的EI、左RLN周围转移淋巴结与RLN麻痹之间的相关性，以及接受和未接受上纵隔淋巴结清扫患者的生存率。

结果

在297例行上纵隔淋巴结清扫的患者中，59例（20%）发生Clavien-Dindo≥II级左RLN麻痹。总体而言，右RLN（7.4）和左RLN（6.6）的EI高于其他站。对于上三分之一或中三分之一肿瘤患者，这种趋势更强。左RLN周围有转移淋巴结的患者比无转移淋巴结的患者更易发生左RLN麻痹（44%对15%，p<0.0001）。在倾向评分匹配后，接受和未接受上纵隔淋巴结清扫的每组各纳入42例患者。在生存分析中，接受和未接受上纵隔淋巴结清扫的患者5年总生存率分别为55%和35%，病因特异性生存率分别为61%和43%。生存曲线存在显著差异（总生存：p=0.03；病因特异性生存：p=0.04）。