Controlling lymph node micrometastases by neoadjuvant chemotherapy affects the prognosis in advanced esophageal squamous cell carcinoma
Controlling lymph node micrometastases by neoadjuvant chemotherapy affects the prognosis in advanced esophageal squamous cell carcinoma
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DOI：
10.1007/s00595-020-02059-7
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发表时间：
2020-06-28
期刊：
影响因子：
2.5
通讯作者：
Yasuda, Takushi
中科院分区：
文献类型：
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作者：
Hiraki, Yoko;Kimura, Yutaka;Yasuda, Takushi
目的探讨新辅助化疗（NAC）对可切除的晚期食管鳞癌（ESCC）微转移的临床意义及不同NAC方案控制微转移的差异。方法分析食管鳞癌患者行食管癌切除术后行淋巴结清扫术的临床资料，化疗方案为阿霉素+顺铂+ 5-氟尿嘧啶（ACF）或多西他赛+顺铂+ 5-氟尿嘧啶（DCF）。微转移定义为宫颈、返神经或腹部淋巴结上的单个孤立癌细胞或癌细胞簇，如抗细胞角蛋白抗体（AE 1/AE 3）免疫组化染色所示。研究微转移、复发、预后和治疗方案差异之间的关系。结果共分析101例患者，其中ACF组51例，DCF组50例。24例患者（23.8%）发生微转移：ACF组17/51例（33.3%），DCF组7/50例（13.5%）（p = 0.0403）。无微转移患者（n = 77）和有微转移患者（n = 24）的5年无复发生存率（RFS）分别为62%和32%（风险比，2.158; 95%置信区间，1.170-3.980;分层对数秩检验，p = 0.0115）。多因素分析显示pN 1或更高分期和微转移是影响RFS的重要危险因素。结论在可切除的晚期食管鳞癌中，NAC治疗后控制淋巴结微转移可能与预防食管鳞癌复发有关。
Purpose The purpose of this study is to determine the clinical significance of micrometastases after neoadjuvant chemotherapy (NAC) and the difference in controlling micrometastases using different NAC regimens in resectable advanced esophageal squamous cell carcinoma (ESCC). Methods We analyzed patients with ESCC who underwent esophagectomy with lymph node dissection after NAC with Adriamycin + cisplatin + 5-fluorouracil (ACF) or docetaxel + cisplatin + 5-fluorouracil (DCF). Micrometastasis was defined as a single isolated cancer cell or cluster of cancer cells on the cervical, recurrent nerve, or abdominal LNs as shown by immunohistochemical staining with anti-cytokeratin antibody (AE1/AE3). The associations between micrometastases, recurrence, prognosis, and regimen differences were investigated. Results One hundred and one cases (ACF group: 51 cases; DCF group: 50 cases) were analyzed. Micrometastases occurred in 24 patients (23.8%): 17/51 (33.3%) in the ACF group and 7/50 (13.5%) in the DCF group (p = 0.0403). The 5-year recurrence-free survival (RFS) rates for patients without (n = 77) and with (n = 24) micrometastases were 62 and 32%, respectively, (hazard ratio, 2.158; 95% confidence interval, 1.170-3.980; stratified log-rank test,p = 0.0115). A multivariate analysis showed that stage pN1 or higher and micrometastases were significant risk factors affecting RFS. Conclusion In resectable advanced ESCC, controlling micrometastases in the LNs after NAC varied by regimen and may be associated with preventing ESCC recurrence.