Korst R J, Rusch V W, Venkatraman E, Bains M S, Burt M E, Downey R J, Ginsberg R J
Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY 10021, USA.
J Thorac Cardiovasc Surg. 1998 Mar;115(3):660-69; discussion 669-70. doi: 10.1016/S0022-5223(98)70332-0.
This study analyzed survival with respect to lymph node involvement to develop a new staging system for patients with esophageal cancer that accurately reflects prognosis.
The records of patients undergoing resection of primary esophageal cancer from 1989 to 1993 were reviewed. The data collected included patient age and sex, tumor histologic characteristics and location, the use of preoperative or postoperative radiation and chemotherapy, the type of resection, the depth of tumor invasion, the number and location of benign and malignant lymph nodes in the resected specimen, the disease status at last follow-up, and the first site of relapse. With an anatomically specific lymph node map, tumors designated in the current American Joint Committee on Cancer system as M1 because of extensive lymph node metastases were reclassified as N2, reserving the M1 category for visceral metastases. Survival was analyzed by the Kaplan-Meier method, and prognostic factors were assessed by log-rank and Cox regression analyses.
There were 216 patients (159 men, 57 women) with a median age of 63.5 years. Adenocarcinoma of the distal esophagus or gastroesophageal junction was the most common tumor (127 patients, 59%) and Ivor Lewis esophagogastrectomy was the most frequently performed operation. Both lymph node location (N1 versus N2) and number (0 vs 1 to 3 vs 4 or more) significantly influenced survival.
A new staging system that adds an N2 M0 descriptor and reclassifies stage groupings reflects prognosis more accurately than does the current American Joint Committee on Cancer staging system. The number of positive lymph nodes is also an important stratification factor.
本研究分析了食管癌患者的生存情况与淋巴结受累的关系，以开发一种能准确反映预后的食管癌新分期系统。
回顾了1989年至1993年接受原发性食管癌切除术患者的记录。收集的数据包括患者年龄和性别、肿瘤组织学特征和位置、术前或术后放疗及化疗的使用情况、切除类型、肿瘤浸润深度、切除标本中良性和恶性淋巴结的数量及位置、最后一次随访时的疾病状态以及复发的首发部位。利用解剖学特定的淋巴结图谱，将当前美国癌症联合委员会系统中因广泛淋巴结转移而指定为M1的肿瘤重新分类为N2，将M1类别保留用于内脏转移。采用Kaplan-Meier方法分析生存情况，并通过对数秩和Cox回归分析评估预后因素。
共有216例患者（159例男性，57例女性），中位年龄为63.5岁。食管远端或胃食管交界处腺癌是最常见的肿瘤（127例患者，59%），Ivor Lewis食管胃切除术是最常施行的手术。淋巴结位置（N1与N2）和数量（0个与1至3个与4个或更多）均对生存有显著影响。
一种增加N2 M0描述符并重新分类分期分组的新分期系统比当前美国癌症联合委员会分期系统更准确地反映预后。阳性淋巴结数量也是一个重要的分层因素。
