Bamba Takeo, Kato Ken, Daiko Hiroyuki, Ito Yoshinori, Kajiwara Takeshi, Fujita Takeo, Miyata Hiroshi, Machida Ryunosuke, Sasaki Keita, Takeuchi Hiroya, Kitagawa Yuko
Department of Gastroenterological Surgery, Niigata Cancer Center Hospital, Chuo-ku, Niigata, Japan.
Department of Head and Neck, Esophageal Medical Oncology, Department of Gastrointestinal Oncology, National Cancer Center Hospital, Tokyo, Japan.
Ann Surg Oncol. 2025 May 9. doi: 10.1245/s10434-025-17420-8.
Although recurrence after curative surgery for cT1bN0M0 clinical stage I (cStage I) esophageal squamous cell carcinoma (ESCC) is not rare, reports of recurrence analyses are sparse. Detailed data on optimal postoperative follow-up evaluation of cStage I ESCC are lacking. This study aimed to evaluate the frequency, characteristics, and predictors of postoperative recurrence in patients with cT1bN0M0 cStage I ESCC.
The study analyzed 210 patients who underwent surgery for cT1bN0M0 cStage I ESCC and a follow-up computed tomography (CT) examination in the prospective multicenter study, JCOG0502. The study categorized the characteristics of postoperative recurrences such as the recurrence sites and whether regional/non-regional lymph nodes (LNs) and single/multiple organs were involved. Backward elimination was applied (p < 0.2) to identify postoperative recurrence predictors and obtained hazard ratios (HRs) based on Fine and Gray's model.
Postoperative recurrence was experienced by 31 patients (14.8%) at one or more of the following sites: regional LNs (n = 18), non-regional LNs (n = 10), lung (n = 2); bone (n = 2), and liver, local recurrence, skin, pleura, pericardium, and other (n = 1 each). In four patients, the first recurrence developed in multiple organs. The median interval between trial registration and the first recurrence was 18.6 months. In multivariable analyses, pathologic nodal metastasis (hazard ratio [HR], 3.29; p = 0.003), tumor location in the upper-thoracic esophagus versus lower-thoracic esophagus (HR, 6.71; p = 0.013), and two-field lymphadenectomy (HR, 4.31; p = 0.001) were independently associated with the development of postoperative recurrence.
The main postoperative recurrence sites of cT1bN0M0 ESCC are the LNs, but recurrence in non-regional LNs or distant organs is also quite common, indicating the importance of post-surgery systemic follow-up evaluation.
尽管cT1bN0M0临床I期（c期I）食管鳞状细胞癌（ESCC）根治性手术后复发并不罕见，但复发分析报告却很少。缺乏关于c期I ESCC术后最佳随访评估的详细数据。本研究旨在评估cT1bN0M0 c期I ESCC患者术后复发的频率、特征及预测因素。
在一项前瞻性多中心研究JCOG0502中，分析了210例行cT1bN0M0 c期I ESCC手术并接受随访计算机断层扫描（CT）检查的患者。该研究对术后复发的特征进行了分类，如复发部位以及是否累及区域/非区域淋巴结（LNs）和单个/多个器官。采用向后剔除法（p<0.2）来确定术后复发的预测因素，并根据Fine和Gray模型获得风险比（HRs）。
31例患者（14.8%）在以下一个或多个部位出现术后复发：区域LNs（n = 18）、非区域LNs（n = 10）、肺（n = 2）、骨（n = 2）、肝、局部复发、皮肤、胸膜、心包及其他部位（各n = 1）。4例患者首次复发发生在多个器官。试验登记至首次复发的中位间隔时间为18.6个月。在多变量分析中，病理淋巴结转移（风险比[HR]，3.29；p = 0.003）、肿瘤位于胸段食管上段与下段相比（HR，6.71；p = 0.013）以及两野淋巴结清扫术（HR，4.31；p = 0.001）与术后复发的发生独立相关。
cT1bN0M0 ESCC术后主要复发部位是LNs，但非区域LNs或远处器官的复发也相当常见，这表明术后系统随访评估的重要性。
