新辅助化疗的益处：新辅助化疗后ypN0患者的预后与单纯接受手术的pN0患者的预后相当吗？

Benefits of neoadjuvant chemotherapy: is the prognosis of ypN0 patients after neoadjuvant chemotherapy comparable to that of pN0 patients undergoing surgery alone?

作者信息

Shiraishi Osamu, Tanaka Koji, Makino Tomoki, Sugase Takahito, Kanemura Takashi, Takeno Atsushi, Sugimura Keijiro, Motoori Masaaki, Kimura Yutaka, Hirao Motohiro, Fujitani Kazumasa, Miyata Hiroshi, Yano Masahiko, Yamasaki Makoto, Doki Yuichiro, Yasuda Takushi

机构信息

Department of Surgery, Kindai University Faculty of Medicine, 377-2 Ohnohigashi, Osaka-Sayama, Osaka, 589-8511, Japan.

Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Suita, Osaka, Japan.

出版信息

Esophagus. 2025 May 20. doi: 10.1007/s10388-025-01132-9.

DOI:10.1007/s10388-025-01132-9

PMID:40394433

Abstract

BACKGROUND

Preoperative treatment has become widely recognized for improving survival in patients with esophageal cancer. The present study aimed to compare the prognosis between patients with pathological node-negative status treated with surgery alone (SA-pN0) and those who were clinically node-positive but converted to ypN0 following neoadjuvant chemotherapy (NAC-ypN0) in cases of advanced thoracic esophageal squamous cell carcinoma (ESCC).

METHODS

This retrospective analysis used a multicenter database of 4849 consecutive patients who underwent treatment for esophageal cancer. Patients with clinical T2 or more advanced ESCC who underwent standard subtotal esophagectomy between 1990 and 2017 were included. The NAC-ypN0 group was compared with the SA-pN0 group in terms of patient characteristics, recurrence patterns, and survival outcomes using propensity score-matched analysis.

RESULTS

In total, 109 patients were classified as NAC-ypN0 and 137 as SA-pN0. Propensity score matching resulted in the selection of 87 patients per group. Compared with the SA-pN0 group, the NAC-ypN0 group had a significantly more advanced clinical TNM stage and underwent significantly more three-field lymphadenectomies. Pathological findings showed downstaging of the pT stage in the NAC-ypN0 group, resulting in an equivalent distribution between the two groups. Additionally, the NAC-ypN0 group had significantly lower rates of lymphatic invasion (33% vs. 56%) and venous invasion (21% vs. 52%). Recurrence rates (21% vs. 22%) and survival outcomes (5-year overall survival: 83.9% vs. 76.1%, P = 0.110) were comparable between the two groups.

CONCLUSIONS

The NAC-ypN0 group demonstrated reduced lymphovascular invasion and showed a prognosis comparable to that of the SA-pN0 group.

摘要

背景

术前治疗已被广泛认可可提高食管癌患者的生存率。本研究旨在比较晚期胸段食管鳞状细胞癌（ESCC）患者中，单纯手术治疗（SA-pN0）的病理淋巴结阴性状态患者与新辅助化疗后临床淋巴结阳性但转为ypN0的患者（NAC-ypN0）之间的预后情况。

方法

本回顾性分析使用了一个包含4849例连续接受食管癌治疗患者的多中心数据库。纳入1990年至2017年间接受标准次全食管切除术的临床T2或更晚期ESCC患者。使用倾向评分匹配分析，在患者特征、复发模式和生存结局方面，将NAC-ypN0组与SA-pN0组进行比较。

结果

总共109例患者被分类为NAC-ypN0，137例为SA-pN0。倾向评分匹配后每组选择87例患者。与SA-pN0组相比，NAC-ypN0组的临床TNM分期明显更晚，接受三野淋巴结清扫术的比例明显更高。病理结果显示NAC-ypN0组的pT分期降期，导致两组之间分布相当。此外，NAC-ypN0组的淋巴侵犯率（33%对56%）和静脉侵犯率（21%对52%）明显更低。两组的复发率（21%对22%）和生存结局（5年总生存率：83.9%对76.1%，P = 0.110）相当。