The number of lymph nodes with metastasis predicts survival in patients with esophageal or esophagogastric junction adenocarcinoma who receive preoperative chemoradiation
The number of lymph nodes with metastasis predicts survival in patients with esophageal or esophagogastric junction adenocarcinoma who receive preoperative chemoradiation
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作者：
Gu, Y;Swisher, SG;Wu, TT
背景。据报道，接受术前放化疗的食管或食管胃结合部 (EGJ) 局部区域腺癌患者的生存率在达到病理完全缓解的患者中优于有残余肿瘤（包括淋巴结 (LN) 转移）的患者。然而，具有残余转移的淋巴结数量的预后意义仍然是核的。方法。作者研究了 187 名连续接受放化疗和食管切除术的患者。根据总生存期（OS）和无复发生存期（RFS）检查阳性淋巴结的数量和每个阳性淋巴结中转移肿瘤的大小。结果。 29% 的患者实现了病理完全缓解。 49% 的残留癌患者不存在 LN 转移（治疗后病理学阴性 LN 状态 [ypN0]），51% 的患者存在 LN 转移 (ypN1)。具有 1 个阳性 LN 的患者所获得的 5 年 OS 和 2 年 RFS 率（分别为 34% 和 45%）与 ypN0 组患者所获得的比率相似（分别为 38% [P = 0.84] 和 50% [P = 0.77]），但显着优于具有 2 个阳性 LN 的患者所获得的比率（分别为 6% [P = 0.02] 和 18%） [P = 0.01]，分别）。在有 1 个阳性 LN 的患者中，LN 转移肿瘤的大小是一个预后因素（4 mm vs. < 4 mm；P = 0.04）。在多变量分析中，vpN1 组患者中有 I LN 转移的患者的 OS 更好 (P = 0.02)，与治疗后肿瘤病理状态无关。结论。目前的结果提示，术前放化疗后食管或食管胃结合部残留腺癌患者中，发生转移的淋巴结数量是一个独立的预后因素。作者建议修改肿瘤淋巴结转移 (TNM) 分期分类 (ypTNM)，以将阳性 LAN 的数量纳入 ypN1 类别。
BACKGROUND. The survival of patients with locoregional adenocarcinoma of the esophagus or the esophagogastric junction (EGJ) who receive preoperative chemoradiation is reported to be better among patients who achieve a pathologic complete response than among patients who have residual tumor, including lymph node (LN) metastasis. However, the prognostic significance of the number of LNs with residual metastasis remains nuclear.METHODS. The authors studied 187 consecutive patients who received chemoradiation followed by an esophagectomy. The number of positive LNs and the size of metastatic tumor in each positive LN were examined with regard to overall survival (OS) and recurrence-free survival (RFS).RESULTS. A pathologic complete response was achieved by 29% of patients. No LN metastasis (posttherapy pathologic negative LN status [ypN0]) was present in 49% of patients who had residual carcinoma, and LN metastasis (ypN1) was present in 51% of patients. The 5-year OS and 2-year RFS rates achieved by patients who had 1 positive LN (34% and 45%, respectively) were similar to the rates achieved by patients in the ypN0 group (38% [P = 0.84] and 50% [P = 0.77], respectively) but were significantly better than the rates achieved by patients who had 2 positive LNs (6% [P = 0.02] and 18% [P = 0.01], respectively). The size of metastatic tumor in LNs among patients who had 1 positive LN was a prognostic factor ( 4 mm vs. < 4 mm; P = 0.04). In multivariate analysis, OS was better in patients who had I LN metastasis among patients in the vpN1 group (P = 0.02) independent of their posttherapy pathologic tumor status.CONCLUSIONS. The current results Suggested that the number of LNs with metastasis is an independent prognostic factor in patients with residual adenocarcinoma of the esophagus or the EGJ after preoperative chemoradiation. The authors suggest modification of the tumor-lymph node-metastasis (TNM) staging classification (ypTNM) to include the number of positive LANs in the ypN1 category.