Department of Surgery, Erasmus MC Cancer Institute, Rotterdam, The Netherlands.
Department of Surgery, Reinier de Graaf Group, Delft, The Netherlands.
Dig Surg. 2024;41(3):133-140. doi: 10.1159/000540468. Epub 2024 Aug 3.
Patients with extensive lymph node metastases have a poor prognosis. Clinical staging of lymph node metastases poses significant challenges given the limited sensitivity and specificity of imaging techniques. The aim of this study was to investigate the overall survival (OS) of patients with N3 disease in a real-world Dutch population and the added value of surgery in these patients.
Patients with cN3M0 esophageal or gastroesophageal cancer were identified from the Netherlands Cancer Registry (2012-2019). Treatment consisted of neoadjuvant chemo(radio)therapy followed by resection or chemo(radio)therapy, radiotherapy, or esophagectomy alone. OS was calculated using the Kaplan-Meier method.
Some 21,566 patients were diagnosed with esophageal cancer of whom 359 (1.7%) had cN3M0 disease. Median OS of these patients was 12.5 months (95% CI: 10.7-14.3). Median OS following chemoradiotherapy alone and neoadjuvant therapy plus surgery was 13.3 months (95% CI: 10.7-15.9) and 23.7 months (95% CI: 18.3-29.2), respectively. Of all patients who underwent esophagectomy, 391 (2.8%) had (y)pN3 disease, and median OS was 16.1 months (95% CI: 14.8-17.4). Twenty-one patients (5.4%) were correctly classified as cN3, and 3-year OS was 21%.
CONCLUSION(S): Clinical staging appears to be difficult, apparently in patients with N3 esophageal cancer. Surgery seems to be of benefit to these patients. More research is required to address the ongoing challenges in clinical staging and the best neoadjuvant therapy.
广泛淋巴结转移的患者预后不良。鉴于影像学技术的敏感性和特异性有限，临床分期淋巴结转移具有显著的挑战性。本研究旨在调查荷兰真实世界中 N3 疾病患者的总生存期（OS），以及手术在这些患者中的附加价值。
从荷兰癌症登记处（2012-2019 年）中确定了 cN3M0 食管或胃食管交界处癌患者。治疗包括新辅助化疗（放疗）后切除或化疗（放疗）、放疗或单纯食管切除术。使用 Kaplan-Meier 方法计算 OS。
21566 名患者被诊断为食管癌，其中 359 名（1.7%）患有 cN3M0 疾病。这些患者的中位 OS 为 12.5 个月（95%CI：10.7-14.3）。单纯放化疗和新辅助治疗加手术的中位 OS 分别为 13.3 个月（95%CI：10.7-15.9）和 23.7 个月（95%CI：18.3-29.2）。所有接受食管切除术的患者中，有 391 名（2.8%）患有（y）pN3 疾病，中位 OS 为 16.1 个月（95%CI：14.8-17.4）。21 名患者（5.4%）被正确分类为 cN3，3 年 OS 为 21%。
临床分期似乎很困难，尤其是在 N3 食管癌患者中。手术似乎对这些患者有益。需要进一步研究以解决临床分期和最佳新辅助治疗中的持续挑战。
