Nguyen Anh Tuan, Pham Van Hiep, Tran Manh Thang, Nguyen Pham Nghia Do
Department of Digestive Surgery, Institute of Digestive Surgery, 108 Military Central Hospital, Hanoi, Vietnam.
College of Health Sciences, VinUniversity, Hanoi, Vietnam.
Transl Gastroenterol Hepatol. 2025 Jan 17;10:8. doi: 10.21037/tgh-24-76. eCollection 2025.
The status of lymph node (LN) metastases in esophageal squamous cell carcinoma (ESCC) following neoadjuvant chemoradiation (NCRT) is not well understood but significantly affects patient prognosis and treatment options. We conducted this study to evaluate the distribution of LN metastases in patients with ESCC who received NCRT combined minimally invasive esophagectomy (MIE).
From March 2019 to September 2023, patients with middle- and lower-third ESCC received NCRT, followed by MIE with two-field lymphadenectomy, were included in this study. The primary outcome was to examine the distribution of LN metastases and their correlation with the radiation fields. Secondary outcomes included identifying risk factors for LN metastases and their impact on long-term survival.
One hundred consecutive patients were included, and 4.11% had LN metastases. The median number of positive LN and the rate of LN metastases in the thoracic LN stations was lower than that of the abdominal region (1.5 and 2.84% 2 and 5.94%, respectively). Over half of the patients had LN metastases within the radiation field. The multivariate analysis found that the LN metastases were associated with the ycN-stage [hazard ratio (HR) =2.03, 95% confidence interval (CI): 1.02-4.04, P=0.04]. Although the LN metastases were not significantly associated with either overall survival (OS) or disease-free survival (DFS) (P=0.89 and P=0.65, respectively), the number of LN removal ≥15 LN removals was significantly improved both OS and DFS (P=0.040 and P=0.049, respectively).
In patients with middle- and lower-third ESCC who underwent NCRT followed by MIE, the rate of LN metastases in the abdominal region is higher than in the thoracic region. The majority of patients had LN metastases within the radiation field. Therefore, NCRT does not justify minimizing lymphadenectomy in ESCC; furthermore, a higher ycN-stage correlated with a higher incidence of LN metastases; higher ycN-stage correlates with higher LN metastases.
新辅助放化疗（NCRT）后食管鳞状细胞癌（ESCC）的淋巴结（LN）转移情况尚未完全明确，但对患者预后和治疗选择有显著影响。我们开展本研究以评估接受NCRT联合微创食管切除术（MIE）的ESCC患者的LN转移分布情况。
2019年3月至2023年9月期间，纳入中下段ESCC患者，这些患者接受NCRT，随后行MIE及两野淋巴结清扫术。主要结局是检查LN转移的分布及其与放疗野的相关性。次要结局包括确定LN转移的危险因素及其对长期生存的影响。
连续纳入100例患者，4.11%有LN转移。胸段LN站阳性LN的中位数及LN转移率低于腹段（分别为1.5和2.84% 2和5.94%）。超过半数患者的LN转移发生在放疗野内。多因素分析发现，LN转移与ycN分期相关[风险比（HR）=2.03，95%置信区间（CI）：1.02 - 4.04，P = 0.04]。尽管LN转移与总生存（OS）或无病生存（DFS）均无显著相关性（分别为P = 0.89和P = 0.65），但切除LN数量≥15枚时，OS和DFS均有显著改善（分别为P = 0.040和P = 0.049）。
在接受NCRT后行MIE的中下段ESCC患者中，腹段的LN转移率高于胸段。大多数患者的LN转移发生在放疗野内。因此，NCRT并不能成为ESCC减少淋巴结清扫的理由；此外，较高的ycN分期与较高的LN转移发生率相关；较高的ycN分期与较高的LN转移相关。
