Kajiyama Daisuke, Fujiwara Naoto, Shigeno Takashi, Sato Kazuma, Yamaguchi Masayuki, Sakashita Shingo, Daiko Hiroyuki, Fujita Takeo
Division of Esophageal Surgery, National Cancer Center Hospital East, Kashiwa, Chiba, Japan.
Course of Advanced Clinical Research of Cancer, Juntendo University Graduate School of Medicine, Tokyo, Japan.
Ann Surg Oncol. 2025 Feb;32(2):860-871. doi: 10.1245/s10434-024-16522-z. Epub 2024 Nov 22.
Lymphovascular invasion (LVI) is reported to correlate with postoperative prognosis in esophageal squamous cell carcinoma (ESCC). However, reports analyzing lymphatic and venous invasion separately are rare, and no studies have examined the correlation in resected specimens after neoadjuvant chemotherapy (NAC). This study evaluated the postoperative prognosis and distant metastatic recurrence patterns in ESCC patients who underwent esophagectomy after NAC.
This retrospective study analyzed 427 ESCC patients who underwent radical esophagectomy after NAC. The study examined the association of LVI patterns with postoperative overall survival (OS), recurrence-free survival (RFS), and distant metastasis-free survival (DMFS). The study also evaluated the correlation with postoperative distant metastasis patterns.
Multivariate analyses showed that patients with venous invasion (VI) alone had significantly worse OS (HR, 2.99; p < 0.001), RFS (HR, 2.92; p < 0.001), and DMFS (HR, 3.63; p < 0.001) than patients without LVI. Patients with both lymphatic invasion (LI) and VI had the worst OS (HR, 4.23; p < 0.001), RFS (HR, 3.38; p < 0.001), and DMFS (HR, 4.59; p < 0.001) among all groups. For the ypN0 patients, VI positivity was the only independent risk factor for DMFS (HR, 5.33; p < 0.001). Regarding distant organ metastasis, liver, brain, and bone metastasis were more frequently detected in patients with both LI and VI than in patients with other LVI patterns.
The study showed that ESCC patients treated with NAC who have resected specimens positive for VI, especially those also with positive lymphatic invasion, have a worse postoperative prognosis and a higher risk for postoperative distant metastases than those without LVI. More aggressive postoperative adjuvant therapy may be suitable for improving the prognosis of such patients.
据报道，淋巴管浸润（LVI）与食管鳞状细胞癌（ESCC）的术后预后相关。然而，分别分析淋巴和静脉浸润的报告很少，且尚无研究在新辅助化疗（NAC）后的切除标本中研究这种相关性。本研究评估了接受NAC后行食管切除术的ESCC患者的术后预后和远处转移复发模式。
这项回顾性研究分析了427例接受NAC后行根治性食管切除术的ESCC患者。该研究检查了LVI模式与术后总生存期（OS）、无复发生存期（RFS）和无远处转移生存期（DMFS）的关联。该研究还评估了与术后远处转移模式的相关性。
多因素分析显示，单纯有静脉浸润（VI）的患者与无LVI的患者相比，OS（风险比[HR]，2.99；P<0.001）、RFS（HR，2.92；P<0.001）和DMFS（HR，3.63；P<0.001）显著更差。在所有组中，既有淋巴浸润（LI）又有VI的患者OS最差（HR，4.23；P<0.001）、RFS最差（HR，3.38；P<0.001）和DMFS最差（HR，4.59；P<0.001）。对于ypN0患者，VI阳性是DMFS的唯一独立危险因素（HR，5.33；P<0.001）。关于远处器官转移，既有LI又有VI的患者比其他LVI模式的患者更常检测到肝、脑和骨转移。
该研究表明，接受NAC治疗且切除标本VI阳性的ESCC患者，尤其是那些同时伴有淋巴浸润阳性的患者，与无LVI的患者相比，术后预后更差，术后远处转移风险更高。更积极的术后辅助治疗可能适合改善此类患者的预后。
