Department of Surgical Oncology, Hiroshima University, Hiroshima, Japan.
Department of Radiation Oncology, Hiroshima University, Hiroshima, Japan.
World J Surg. 2024 Feb;48(2):416-426. doi: 10.1002/wjs.12033. Epub 2023 Dec 13.
Pathological lymph node metastasis (LNM) following multimodal therapy is an important indicator of poor prognosis in patients with esophageal cancer. However, a significant number of patients without LNM are still at high risk for recurrence.
We assessed prognostic factors in 143 patients without pathological LNM who were diagnosed with locally advanced esophageal squamous cell carcinoma (ESCC) and underwent neoadjuvant chemotherapy (NAC) or chemoradiotherapy (NACRT), followed by surgery.
Using univariate and multivariate analyses of recurrence-free survival, carcinoembryonic antigen (CEA) levels (hazard ratio [HR]: 2.17, 95% confidence interval [CI]: 1.12-4.23, and p = 0.02) and neutrophil-to-lymphocyte ratio (NLR) (HR: 1.22, 95% CI: 1.04-1.43, and p = 0.02) were significant independent covariates. Furthermore, pretherapeutic LNM (HR: 1.94, 95% CI: 1.003-3.76, and p = 0.049), NACRT (HR: 3.29, 95% CI: 1.30-8.33, and p = 0.01), poorly differentiated tumors (HR: 2.52, 95% CI: 1.28-4.98, and p = 0.01), and lymphovascular invasion (LVI) (HR: 2.78, 95% CI: 1.27-6.09, and p = 0.01) were also significant independent covariates. The recurrence rates among patients with 0/1, 2, 3, and 4/5 poor prognostic factors were significantly different (5.0%, 25.0%, 35.7%, and 53.8%, respectively; p = 0.001); the survival rates were stratified among these prognostic groups.
Pretherapeutic CEA and NLR levels, pretherapeutic LNM, NACRT, poorly differentiated tumors, and LVI were significantly correlated with survivals in patients without pathological LNM after neoadjuvant therapy and surgery. Postoperative therapy should be considered in patients with ESCC with several indicators of recurrence, even in those without pathological LNM who underwent surgery following neoadjuvant therapy.
接受多模式治疗后的病理性淋巴结转移（LNM）是食管癌患者预后不良的重要指标。然而，仍有相当数量无 LNM 的患者存在高复发风险。
我们评估了 143 例局部晚期食管鳞状细胞癌（ESCC）患者的预后因素，这些患者接受了新辅助化疗（NAC）或放化疗（NACRT），然后进行了手术。
使用无进展生存的单因素和多因素分析，癌胚抗原（CEA）水平（危险比[HR]：2.17，95%置信区间[CI]：1.12-4.23，p=0.02）和中性粒细胞与淋巴细胞比值（NLR）（HR：1.22，95%CI：1.04-1.43，p=0.02）是显著的独立预测因素。此外，治疗前 LNM（HR：1.94，95%CI：1.003-3.76，p=0.049）、NACRT（HR：3.29，95%CI：1.30-8.33，p=0.01）、低分化肿瘤（HR：2.52，95%CI：1.28-4.98，p=0.01）和脉管侵犯（LVI）（HR：2.78，95%CI：1.27-6.09，p=0.01）也是显著的独立预测因素。具有 0/1、2、3 和 4/5 个不良预后因素的患者的复发率有显著差异（分别为 5.0%、25.0%、35.7%和 53.8%，p=0.001）；这些预后组之间的生存率进行了分层。
治疗前 CEA 和 NLR 水平、治疗前 LNM、NACRT、低分化肿瘤和 LVI 与新辅助治疗和手术后无病理性 LNM 患者的生存显著相关。对于 ESCC 患者，即使在接受新辅助治疗和手术后无病理性 LNM 的患者中，也应考虑术后治疗。
