Extracapsular lymph node involvement in node-positive patients with adenocarcinoma of the distal esophagus or gastroesophageal junction
Extracapsular lymph node involvement in node-positive patients with adenocarcinoma of the distal esophagus or gastroesophageal junction
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DOI：
10.1097/01.pas.0000189182.92815.12
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发表时间：
2006-02-01
影响因子：
5.6
通讯作者：
van Lanschot, JJB
中科院分区：
文献类型：
--
作者：
Lagarde, SM;ten Kate, FJW;van Lanschot, JJB
在食管或胃食管交界处的腺癌中，很少有人关注包膜外淋巴结受累（LNI）的生物学意义。在本研究中，对 251 名淋巴结转移患者的连续系列进行了回顾。所有患者均接受了食管腺癌切除术并进行了前瞻性随访。共复查1562个阳性淋巴结。在 166 名患者 (66%) 的 456 个淋巴结 (29%) 中发现了囊外 LNI。 63 名患者 (38%) 的囊外 LNI 仅限于 1 个淋巴结。包膜外LNI的发生率随着浸润深度、阳性可切除的躯干淋巴结的存在、切除的淋巴结数量、阳性淋巴结数量和淋巴结比例的增加而显着增加。中位潜在随访期为 58 个月（范围：12-143 个月）。在此期间，有178名患者死于疾病复发。有和没有囊外 LNI 的患者之间的复发模式相当（P = 0.938）。囊外 LNI 患者的中位生存期为 15 个月（95% 置信区间，12-18 个月），而无囊外 LNI 患者的中位生存期为 41 个月（95% 置信区间，19-64 个月）（P < 0.001）。具有 2 个或更多淋巴结的患者的中位生存期为 12 个月（95% 置信区间，8-15 个月）。多变量分析表明T分期、囊外LNI和淋巴结比率是独立的预后因素。囊外 LNI 的存在表明一个亚组的长期生存率明显较差。与 T 分期和淋巴结比率一起，囊外 LNI 反映了一种特别具有侵袭性的生物学行为，并且具有显着的预后潜力。
In adenocarcinoma of the esophagus or gastroesophageal junction, little attention has been paid to the biologic significance of extracapsular lymph node involvement (LNI). In the present study, a consecutive series of 251 patients with lymph node dissemination were reviewed. All patients underwent esophagectomy for adenocarcinoma and were prospectively followed. A total of 1562 positive lymph nodes were reexamined. Extracapsular LNI was identified in 456 lymph nodes (29%) in 166 patients (66%). Extracapsular LNI was confined to one lymph node in 63 patients (38%). The occurrence of extracapsular LNI increased significantly with the depth of invasion, presence of positive resectable truncal nodes, number of resected nodes, number of positive nodes, and lymph node ratio. The median potential follow-up period was 58 months (range, 12-143 months). In this period, 178 patients died of recurrent disease. The pattern of recurrence was comparable between patients with and without extracapsular LNI (P = 0.938). The median survival in patients with extracapsular LNI was 15 months (95% confidence interval, 12-18 months) compared with 41 months (95% confidence interval, 19-64 months) in those without extracapsular LNI (P < 0.001). Median survival of patients with 2 or more lymph nodes was 12 months (95% confidence interval, 8-15 months). Multivariate analysis demonstrated that T-stage, extracapsular LNI, and lymph node ratio were independent prognostic factors. The presence of extracapsular LNI identifies a subgroup with a significantly worse long-terrn survival. Together with the T-stage and the lymph node ratio, extracapsular LNI reflects a particularly aggressive biologic behavior and has significant prognostic potential.