Division of Thoracic Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan.
Division of Thoracic Surgery, Department of Surgery, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan.
Dis Esophagus. 2024 Oct 28;37(11). doi: 10.1093/dote/doae064.
The role of surgery in oligometastatic esophageal squamous cell carcinoma (ESCC) remains controversial. This study evaluated the oncological outcomes after esophagectomy in patients with ESCC with distant lymph node (LN) metastasis. Patients with ESCC and nodal metastasis treated with chemoradiotherapy or chemotherapy followed by esophagectomy between 2010 and 2020 were included. Overall survival (OS) and recurrence-free survival (RFS) were compared between patients with distant LN metastasis (dLN+) and exclusively regional LN metastasis (dLN-). The cohort comprised 69 dLN+ and 111 dLN- patients. Survival was significantly better in the dLN- group than in the dLN+ group (5-year OS, 51.9% vs. 25.5%, P < 0.001; RFS, 47.2% vs. 18.1%, P < 0.001). Stratified by the yp stage, 49 (44.1%) dLN- and 30 (43.5%) dLN+ patients achieved a pathological complete response (pCR). In the dLN- and dLN+ groups, the OS rates were significantly higher in the pCR group than in the non-pCR group (dLN-: 76.7% vs. 32.4%, P < 0.001; dLN+: 39.6% vs. 14.2%; P = 0.002). The dLN-/pCR group had the best OS, significantly outperforming the dLN-/non-pCR and dLN+/pCR groups. OS did not differ between the dLN-/non-pCR and dLN+/pCR groups. The dLN+/non-pCR group had the worst OS. The RFS analysis paralleled the OS findings. Patients with dLN+ disease had worse outcomes than their dLN- counterparts, irrespective of the pCR status. The survival rates were poor but comparable between the dLN+/pCR and dLN-/non-pCR groups. Adjuvant therapy may be required for dLN+ patients following systemic treatment and surgery, even after achieving pCR.
手术在寡转移食管鳞癌（ESCC）中的作用仍存在争议。本研究评估了经放化疗或化疗后行食管癌切除术的 ESCC 伴远处淋巴结（LN）转移患者的肿瘤学结局。纳入 2010 年至 2020 年间接受放化疗或化疗后继行食管癌切除术的 ESCC 伴淋巴结转移患者。比较远处 LN 转移（dLN+）和仅区域 LN 转移（dLN-）患者的总生存（OS）和无复发生存（RFS）。队列包括 69 例 dLN+和 111 例 dLN-患者。dLN-组的生存明显优于 dLN+组（5 年 OS，51.9% vs. 25.5%，P<0.001；RFS，47.2% vs. 18.1%，P<0.001）。按 yp 分期分层，49 例（44.1%）dLN-和 30 例（43.5%）dLN+患者达到病理完全缓解（pCR）。在 dLN-和 dLN+组中，pCR 组的 OS 率明显高于非 pCR 组（dLN-：76.7% vs. 32.4%，P<0.001；dLN+：39.6% vs. 14.2%；P=0.002）。dLN-/pCR 组的 OS 最佳，明显优于 dLN-/non-pCR 和 dLN+/pCR 组。dLN-/non-pCR 和 dLN+/pCR 组的 OS 无差异。dLN+/non-pCR 组的 OS 最差。RFS 分析与 OS 结果一致。dLN+疾病患者的预后较 dLN-患者差，与 pCR 状态无关。尽管 dLN+/pCR 和 dLN-/non-pCR 两组的生存率相似，但都很差。即使达到 pCR，接受系统治疗和手术治疗后的 dLN+患者可能仍需要辅助治疗。
