Wu Yahua, Gu Weiwei, Du Bin, Lv Chengliu, Yao Na, Zhu Yingjiao, Ouyang Jingxiang, Lai Jinhuo
Department of Medical Oncology, Fujian Medical University Union Hospital, Fuzhou, 350000, Fujian, China.
Department of Medical Oncology, People's Hospital Affiliated to Shandong First Medical University, Jinan, 271100, Shandong, China.
J Cancer. 2024 Jun 3;15(13):4197-4204. doi: 10.7150/jca.96574. eCollection 2024.
Elderly patients with locally advanced esophageal adenocarcinoma (EAC) have a poor prognosis. The purpose of this study was to identify prognostic factors and construct a risk stratification for assessing the prognosis of elderly (≥ 70 years old) EAC patients who receiving neoadjuvant chemoradiotherapy (NCRT) and esophagectomy. A total of 688 patients with non-metastatic locally advanced EAC who underwent NCRT and esophagectomy were selected from the Surveillance Epidemiology and End Results (SEER) database. Multivariable Cox analysis was used to identify prognostic factors of overall survival (OS). Restricted Cubic Splines (RCS) was used to examine the linear relationship between the number of lymph node dissection (LND) and OS. RCS showed a linear relationship between LND and OS (P = 0.690). As the number of LND increased, the risk of death decreased. Multivariable analysis demonstrated that LND > 23, grade III/IV, and regional node positive were independent prognostic factors. Subgroup analysis indicated that enlarged lymph node dissection (LND > 23) did not improve OS in patients with grade I/II or T1-2 stage, whereas enlarged lymph node dissection significantly improved OS in patients with grade III/IV or T3-4 stage. Furthermore, we constructed a novel risk score based on LND, grade, and regional node status, which stratified patients into low-, medium-, and high-risk groups. Patients in the high-risk group (risk score = 3) had a worse prognosis. Enlarged lymph node dissection (LND > 23) improved OS in patients with grade III/IV or T3-4 stage. Moreover, a novel risk score was constructed, which facilitated risk stratification and postoperative surveillance in elderly EAC patients.
局部晚期食管腺癌（EAC）老年患者预后较差。本研究旨在确定预后因素，并构建风险分层系统，以评估接受新辅助放化疗（NCRT）和食管切除术的老年（≥70岁）EAC患者的预后。从监测、流行病学和最终结果（SEER）数据库中选取了688例接受NCRT和食管切除术的非转移性局部晚期EAC患者。采用多变量Cox分析确定总生存期（OS）的预后因素。使用限制立方样条（RCS）检验淋巴结清扫数量（LND）与OS之间的线性关系。RCS显示LND与OS之间存在线性关系（P = 0.690）。随着LND数量增加，死亡风险降低。多变量分析表明，LND>23、III/IV级和区域淋巴结阳性是独立的预后因素。亚组分析表明，对于I/II级或T1-2期患者，扩大淋巴结清扫（LND>23）并未改善OS，而对于III/IV级或T3-4期患者，扩大淋巴结清扫显著改善了OS。此外，我们基于LND、分级和区域淋巴结状态构建了一个新的风险评分系统，将患者分为低、中、高风险组。高风险组（风险评分为3）患者预后较差。扩大淋巴结清扫（LND>23）改善了III/IV级或T3-4期患者的OS。此外，构建了一个新的风险评分系统，有助于老年EAC患者的风险分层和术后监测。
