Pathological Regression of Lymph Nodes Better Predicts Long-term Survival in Esophageal Cancer Patients Undergoing Neoadjuvant Chemotherapy Followed by Surgery.
Pathological Regression of Lymph Nodes Better Predicts Long-term Survival in Esophageal Cancer Patients Undergoing Neoadjuvant Chemotherapy Followed by Surgery.
复制标题
DOI：
10.1097/sla.0000000000004238
复制
发表时间：
2022-06-01
影响因子：
9
通讯作者：
中科院分区：
文献类型：
--
作者：
评价转移性淋巴结对NAC的病理反应，并评估其在EC患者中的临床预后意义。术前治疗的病理反应通常在PT中进行评估。然而，LN转移与全身微转移密切相关。因此，病理评价LN反应可以更准确地预测术前行NAC的EC患者的预后。在2010年1月至2016年12月期间，我们招募了371名连续接受三联体NAC和EC手术的患者。病理LN消退级别由所有转移性LN在整个肿瘤床面积内存活肿瘤面积的比例定义：I级，bb0 50%；第二,10% - -50%;第三,< 10%;IV, 0%。我们分析了分级与临床病理参数的相关性。319例临床LN阳性患者中，115/51/58/95例患者LN病理消退等级为I/II/III/IV级，191例（59.9%）患者PT与LN病理消退等级不一致。LN回归等级与cN阳性数、ypTNM、淋巴血管侵袭及临床/病理PT反应显著相关。无复发生存率的多因素分析显示，LN回归等级[危险比(HR) = 2.25, P < 0.001]、ypT （HR = 1.65, P = 0.005）和ypT （HR = 1.62, P = 0.004）是独立的预后因素，而病理PT回归等级不是独立的预后因素（P = 0.67）。与PT反应相比，病理LN反应更好地预测了接受NAC +根治性手术的EC患者的长期生存。
To evaluate pathological response to NAC in metastatic LNs, and assess its clinical prognostic significance in patients with EC. The pathological response to preoperative treatment is commonly evaluated in the PT. However, LN metastases strongly correlate with systemic micro-metastases. Thus, pathological evaluation of LN response could more accurately predict prognosis in EC patients undergoing NAC before surgery. We enrolled 371 consecutive patients who underwent triplet NAC followed by surgery for EC between January 2010 and December 2016. Pathological LN regression grade was defined by the proportion of viable tumor area within the whole tumor bed area for all metastatic LNs: grade I, >50%; II, 10%–50%; III, <10%; and IV, 0%. We analyzed the correlation of grade with clinico-pathological parameters. Among 319 patients with clinically positive LNs, pathological LN regression grades were I/II/III/IV in 115/51/58/95 patients, and 191 patients (59.9%) showed discordance between the PT and LN pathological regression grades. LN regression grade significantly correlated with cN positive number, ypTNM, lymphovascular invasion, and clinical/pathological PT response. Multivariate analysis for recurrence-free survival revealed that LN regression grade [hazard ratio (HR) = 2.25, P < 0.001], ypT (HR = 1.65, P = 0.005), and ypT (HR = 1.62, P = 0.004) were independent prognostic factors, but not pathological PT regression grade (P = 0.67). Compared to PT response, pathological LN response better predicted long-term survival in EC patients who received NAC plus curative surgery.