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食管癌术前放化疗患者中,淋巴结清扫数目影响 III 期食管癌的预后。

Number of Retrieved Lymph Nodes during Esophagectomy Affects the Outcome of Stage III Esophageal Cancer in Patients Having Had Pre-Operative Chemo-Radiation Therapy.

机构信息

Department of Thoracic & Cardiovascular Surgery, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung 833, Taiwan.

Department of Hematology-Oncology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung 833, Taiwan.

出版信息

Curr Oncol. 2024 Sep 25;31(10):5762-5773. doi: 10.3390/curroncol31100428.


DOI:10.3390/curroncol31100428
PMID:39451732
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11505944/
Abstract

Lymphadenectomy plays a crucial role in the surgical management of early- stage esophageal cancer. However, few studies have examined lymphadenectomy outcomes in advanced stages, particularly in patients who initially underwent concurrent chemoradiation therapy. This retrospective study investigates the effect of lymphadenectomy in patients diagnosed with AJCC 8th-edition clinical stage III esophageal squamous cell carcinoma who received concurrent preoperative chemoradiation. Data from 1994 to 2023 were retrieved from our retrospective database. All patients underwent a uniform evaluation and treatment protocol, including preoperative concurrent chemoradiation therapy comprising cisplatin and 5-fluorouracil, followed by esophagectomy. The analysis encompassed clinical T and N stages, tumor location, tumor grade, pathological T and N stages, pathological stage, and the extent of lymph node dissection. Overall survival, "Free-To-Recurrence", and disease-free survival were assessed via Kaplan-Meier survival curves and the Cox regression model for multivariate analysis. The dataset was stratified into two groups according to extent of lymph node dissection, with one group having <15 dissected nodes and the other having ≥15 dissected nodes. The group with <15 nodes exhibited a shorter "Free-To-Recurrence", worse disease-free survival, and lower overall survival. In multiple-variate analysis (Cox regression model), the number of dissected lymph nodes emerged as a significant factor influencing overall survival and freedom from recurrence. The quantity of lymphadenectomy is a crucial determinant for patients with AJCC 8th-edition clinical stage III esophageal squamous cell carcinoma receiving preoperative concurrent chemoradiation.

摘要

淋巴结清扫术在早期食管癌的外科治疗中起着至关重要的作用。然而,很少有研究探讨晚期食管癌患者淋巴结清扫术的结果,特别是那些最初接受同步放化疗的患者。本回顾性研究调查了接受术前同步放化疗的 AJCC 第 8 版临床 III 期食管鳞癌患者淋巴结清扫术的效果。数据来自我们的回顾性数据库,时间范围为 1994 年至 2023 年。所有患者均接受了统一的评估和治疗方案,包括顺铂和 5-氟尿嘧啶的术前同步放化疗,然后进行食管切除术。分析包括临床 T 和 N 分期、肿瘤位置、肿瘤分级、病理 T 和 N 分期、病理分期以及淋巴结清扫的范围。通过 Kaplan-Meier 生存曲线和 Cox 回归模型进行多变量分析,评估总生存、“无复发生存”和无病生存。根据淋巴结清扫范围将数据集分为两组,一组有<15 个淋巴结,另一组有≥15 个淋巴结。淋巴结清扫<15 个的组无复发生存较短,无病生存和总生存较差。多变量分析(Cox 回归模型)显示,淋巴结清扫数量是影响总生存和无复发的重要因素。淋巴结清扫量是接受术前同步放化疗的 AJCC 第 8 版临床 III 期食管鳞癌患者的重要决定因素。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/3d2f/11505944/e4ed4ab3e8b6/curroncol-31-00428-g004.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/3d2f/11505944/2f771a354665/curroncol-31-00428-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/3d2f/11505944/30b79ea86356/curroncol-31-00428-g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/3d2f/11505944/2042cb79cfcf/curroncol-31-00428-g003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/3d2f/11505944/e4ed4ab3e8b6/curroncol-31-00428-g004.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/3d2f/11505944/2f771a354665/curroncol-31-00428-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/3d2f/11505944/30b79ea86356/curroncol-31-00428-g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/3d2f/11505944/2042cb79cfcf/curroncol-31-00428-g003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/3d2f/11505944/e4ed4ab3e8b6/curroncol-31-00428-g004.jpg

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引用本文的文献

[1]
Impact of Dissected Lymph Node Count and Positive Lymph Node Ratio Following Esophagectomy on Long-Term Outcomes in Esophageal Cancer: A Systematic Review and Meta-Analysis.

Ann Surg Open. 2025-6-13

[2]
ASO Author Reflections: Insights into Sentinel Lymph Node Mapping for Esophageal Cancer.

Ann Surg Oncol. 2025-5-30

[3]
Sentinel Lymph Node Mapping in Esophageal Cancer: Current Status and Future Directions.

Ann Surg Oncol. 2025-5-22

本文引用的文献

[1]
Prognostic significance of the number of lymph nodes dissection in esophageal adenocarcinoma patients.

Transl Cancer Res. 2020-5

[2]
Prognostic impact of lymph node harvest for patients with node-negative esophageal squamous cell carcinoma: a large-scale multicenter study.

J Gastrointest Oncol. 2021-10

[3]
Oesophageal adenocarcinoma: In the era of extended lymphadenectomy, is the value of neoadjuvant therapy being attenuated?

World J Gastrointest Surg. 2021-10-27

[4]
Ten-Year Outcome of Neoadjuvant Chemoradiotherapy Plus Surgery for Esophageal Cancer: The Randomized Controlled CROSS Trial.

J Clin Oncol. 2021-6-20

[5]
Prognostic value of the extent of lymphadenectomy for esophageal cancer-specific survival among T1 patients.

BMC Cancer. 2021-4-14

[6]
The Impact of Radiotherapy Dose in Patients with Locally Advanced Esophageal Squamous Cell Carcinoma Receiving Preoperative Chemoradiotherapy.

Curr Oncol. 2021-3-29

[7]
Global Cancer Statistics 2020: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries.

CA Cancer J Clin. 2021-5

[8]
A More Extensive Lymphadenectomy Enhances Survival After Neoadjuvant Chemoradiotherapy in Locally Advanced Esophageal Adenocarcinoma.

Ann Surg. 2022-8-1

[9]
What is the difference between overall survival, recurrence-free survival and time-to-recurrence?

Br J Surg. 2020-11

[10]
How Many Nodes Need to be Removed to Make Esophagectomy an Adequate Cancer Operation, and Does the Number Change When a Patient has Chemoradiotherapy Before Surgery?

Ann Surg Oncol. 2019-10-11

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