Influence of Neoadjuvant Chemoradiation on the Number and Size of Analyzed Lymph Nodes in Esophageal Cancer
Influence of Neoadjuvant Chemoradiation on the Number and Size of Analyzed Lymph Nodes in Esophageal Cancer
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DOI：
10.1245/s10434-010-1196-8
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发表时间：
2010-12-01
影响因子：
3.7
通讯作者：
Hoelscher, Arnulf H.
中科院分区：
文献类型：
--
作者：
Bollschweiler, Elfriede;Besch, Sarah;Hoelscher, Arnulf H.
研究表明，除原发肿瘤反应外，RTx/CTx术后淋巴结状态是晚期食管癌最重要的预后因素之一。本研究的目的是探讨新辅助放化疗（RTx/CTx）对淋巴结（LN）的影响。从1997年到2006年，297例晚期食管癌患者接受了手术治疗。其中192例接受术前放化疗（5-FU，顺铂，36 Gy）。选择以下匹配的亚组：第一组，单独手术20例，腺癌（AC） 10例，鳞状细胞癌（SCC） 10例；II组，20例轻度缓解（10例AC， 10例SCC）；III组，20例主要缓解（10例AC， 10例SCC）。根据科隆回归量表（Cologne Regression Scale）将肿瘤反应分为“轻微”或“严重”，LN的大小由测量到的最大直径决定。共检查了60例患者的1967个淋巴结。其中161例淋巴结转移。与预处理组相比，I组每位患者检查的LNs中位数没有显著增加（32 vs 31）。I组和II组65%的病例有淋巴结转移，而III组只有20% （p = 0.011）。预处理后的LNMs中位直径（5.0 mm）显著小于未预处理的LNMs中位直径（7.0 mm） （p < 0.02）。非转移性淋巴结大小在三组之间没有差异。有和没有转移的淋巴结大小在AC和SCC之间或主要和次要应答者之间没有差异。由于对新辅助放化疗反应良好，无论组织学类型如何，转移灶的大小和数量均显著减少。
Studies have shown that along with primary tumor response, lymph node status after RTx/CTx is one of the most important prognostic factors for advanced esophageal carcinoma. The goal of our study was to investigate the influence of neoadjuvant radiochemotherapy (RTx/CTx) on lymph nodes (LN).From 1997 until 2006, 297 patients underwent surgery for advanced esophageal carcinoma. Of these, 192 received preoperative chemoradiation (5-FU, cisplatin, 36 Gy). The following matched subgroups were chosen: Group I, 20 with surgery alone: 10 adenocarcinoma (AC), 10 squamous cell carcinoma (SCC); Group II, 20 with minor response (10 AC, 10 SCC); Group III, 20 with major response (10 AC, 10 SCC). Tumor response was graded as "minor" or "major" according to the Cologne Regression Scale, the LN size determined by the largest measured diameter.A total of 1967 LNs from 60 patients were examined. Of these, 161 LNs showed metastasis. The median number of LNs examined per patient was not significantly higher in group I compared with the group with pretreatment (32 vs 31). Group I and group II showed LN metastasis (LNM) in 65% of cases, and group III in only 20% (p = 0.011). LNMs after pretreatment had significantly smaller median diameters (5.0 mm) than those without (7.0 mm) (p < 0.02). Nonmetastatic LN size did not vary between the three groups. LN size with and without metastasis did not differ between AC and SCC or between major and minor responders.With good response to neoadjuvant radiochemotherapy, the size and the number of metastatic LNs is significantly reduced regardless of histologic cancer type.