Ao Yong, Fu Xiayu, Luo Kongjia, Shao Lu, Chen Junying, Zhong Leqi, Zhang Xin, Li Shining, Lin Xiaodan, Leng Changsen, Fu Jianhua, Hu Yi
State Key Laboratory of Oncology in South China, Department of Thoracic Oncology, Sun Yat-sen University Cancer Center, Guangzhou, China.
Collaborative Innovation Center for Cancer Medicine, Guangzhou, China.
Ann Surg Oncol. 2025 May 3. doi: 10.1245/s10434-025-17331-8.
This study aimed to compare the long-term oncologic outcomes of NIRF-guided mediastinal lymphadenectomy during esophagectomy with those of conventional surgery.
The study enrolled consecutive patients who underwent esophagectomy for esophageal cancer by a single surgical team between September 2017 and July 2021. Patients treated after September 2019 received NIRF-guided mediastinal lymphadenectomy (NIRF group) and were compared with the earlier cohort (historical control group). Propensity-matching analysis was used to compare 3-year overall survival (OS), disease-free survival (DFS), and recurrence patterns between the groups. Survival outcomes were analyzed using Kaplan-Meier curves and Cox regression analysis.
The final analysis included 118 matched patients (NIRF group, 59; historical control group, 59). The median follow-up period for all the patients was 38 months (range, 33-42 months). The NIRF group showed a significantly higher number of total lymph nodes (P = 0.010) and mediastinal lymph nodes (P = 0.045) dissected than the historical control group. The 1- and 3-year DFS rates were 68.1% and 45.2% for the NIRF group versus 74.3% and 55.2% for the historical control group. The OS rates for the NIRF group were 90.6% (1-year rate) and 72.0% (3-year rate) versus 98.3% (1-year rate) and 76.9% (3-year rate) for the historical control group. Both OS and DFS were comparable between the two groups (P = 0.271 and P = 0.356, log-rank test, respectively). Additionally, the two groups had similar recurrence patterns (P = 0.053).
The use of NIRF imaging during esophagectomy facilitates precise resection of mediastinal lymph nodes. However, its impact on patient survival remains limited.
本研究旨在比较近红外荧光（NIRF）引导下食管癌切除术同期纵隔淋巴结清扫术与传统手术的长期肿瘤学结局。
本研究纳入了2017年9月至2021年7月期间由同一手术团队进行食管癌切除术的连续患者。2019年9月后接受治疗的患者接受了NIRF引导下的纵隔淋巴结清扫术（NIRF组），并与早期队列（历史对照组）进行比较。采用倾向评分匹配分析比较两组之间的3年总生存期（OS）、无病生存期（DFS）和复发模式。使用Kaplan-Meier曲线和Cox回归分析生存结局。
最终分析纳入了118例匹配患者（NIRF组59例；历史对照组59例）。所有患者的中位随访期为38个月（范围33 - 42个月）。NIRF组清扫的总淋巴结数（P = 0.010）和纵隔淋巴结数（P = 0.045）均显著高于历史对照组。NIRF组的1年和3年DFS率分别为68.1%和45.2%，而历史对照组分别为74.3%和55.2%。NIRF组的OS率为90.6%（1年率）和72.0%（3年率），历史对照组为98.3%（1年率）和76.9%（3年率）。两组的OS和DFS均具有可比性（分别为P = 0.271和P = 0.356，对数秩检验）。此外，两组的复发模式相似（P = 0.053）。
食管癌切除术中使用NIRF成像有助于精确切除纵隔淋巴结。然而，其对患者生存的影响仍然有限。
