Extracapsular Lymph Node Involvement Is a Negative Prognostic Factor After Neoadjuvant Chemoradiotherapy in Locally Advanced Esophageal Cancer
Extracapsular Lymph Node Involvement Is a Negative Prognostic Factor After Neoadjuvant Chemoradiotherapy in Locally Advanced Esophageal Cancer
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DOI：
10.1097/jto.0b013e31819c862d
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发表时间：
2009-04-01
影响因子：
20.4
通讯作者：
Thomas, Pascal
中科院分区：
文献类型：
--
作者：
D'Journo, Xavier Benoit;Avaro, Jean Philippe;Thomas, Pascal
简介：评估预后取决于淋巴结受累（LNI）是否是囊内或囊外突破与新辅助放化疗和surgery.Methods治疗的局部晚期食管癌患者：94例食管癌分期1113（n = 17）和III（n = 77）接受新辅助放化疗，然后经胸食管切除术与两个字段淋巴结切除术。组织学为鳞状细胞癌（n = 46）和腺癌（n = 48）。新辅助治疗包括5-氟尿嘧啶/顺铂联合45-戈伊放疗。根据淋巴结状态和浸润/切除淋巴结比率（LNR）分析无病生存期（DFS）（不包括住院死亡率）。通过多因素分析研究影响生存率的临床因素或囊外浸润的预测因素。结果如下：NO患者（n = 56）、囊内LNI患者（n = 18）和囊外LNI患者（n = 10）的5年DFS率分别为46%、36%和11%（p = 0.002）。LNR = 0.1的囊内LNI患者（n = 6）的DFS率与囊外LNI患者相似（18 vs 11%，p = 0.69）。多变量分析显示，影响DFS的唯一独立因素是囊外LNI（HR = 3.9，p = 0.026）。结论：新辅助放化疗后，囊内与囊外淋巴结浸润的无病生存率有显著性差异（HR = 2.39，p = 0.008）。关节囊外浸润似乎是影响生存率的一个独立的负性预后因素，其存在与浸润LN的数量有关。
Introduction: To assess prognosis depending on whether lymph node involvement (LNI) is intracapsular or with extracapsular breakthrough in patients with a locally advanced esophageal cancer treated with neoadjuvant chemoradiation and surgery.Methods: Ninety-four consecutive patients with an esophageal cancer staged 1113 (n = 17) and III (n = 77) received neoadjuvant chemoradiation followed by transthoracic esophagectomy with two-field lymphadenectomy. Histology was squamous cell carcinoma (n = 46) and adenocarcinoma (n = 48). Neoadjuvant therapy consisted of association of 5-fluorouracil/cisplatin concomitantly with a 45-Gy radiation therapy. Disease-free Survival (DFS) excluding the in-hospital mortality was analyzed according to the nodal status and the invaded/resected lymph node ratio (LNR). Clinical factors affecting survival or predictors of extracapsular invasion were investigated by multivariate analysis..Results: Five-year DFS rates were 46, 36, and 11% in NO patients (n = 56), intracapsular LNI patients (n 18), and extracapsular LNI patients (n = 10), respectively (p = 0.002). Intracapsular LNI patients with an LNR = 0.1 (n = 6) had a DFS rate similar to extracapsular LNI patients (18 versus 11%, p = 0.69). Multivariate analysis revealed that the sole independent factor affecting DFS was the extracapsular LNI (HR = 3.9, p = 0.026). The number of invaded LN seemed to be the sole significant predictive factor for the development of ECLNI (HR = 2.39, p = 0.008).Conclusion: After neoadjuvant chemoradiotherapy, there was a significant difference on DFS depending on whether LNI was intracapsular or extracapsular. Extracapsular invasion seems to be an independent negative prognostic factor affecting survival, and its presence is related to the number of invaded LN.