Predictive value of postoperative lymph node status for adjuvant therapy in esophageal cancer patients after radical resection
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摘要:
目的 分析食管癌患者术后的淋巴结状态对术后辅助治疗方案选择的预测价值及与预后的关系。 方法 分析2007年1月至2010年12月河北医科大学第四医院354例食管癌根治术后患者，对其淋巴结各相关参数与术后辅助治疗进行预后分析。单因素生存分析采用Kaplan-Meier法和Log-rank检验，多因素生存分析采用Cox回归模型。 结果 全组患者1、3、5年生存率分别为84.46%、64.12%和54.06%，中位生存期为86.49个月。N0、N1、N2、N3期患者的5年生存率分别为93.13%、55.50%、19.80%和3.45%，不同N分期之间的差异具有统计学意义（χ2=225.161，P < 0.001）。通过ROC曲线获取阳性淋巴结数目与清扫总淋巴结数目的比值（LNR）为分组界值8.51%将其分为两组并进行生存分析，LNR≤8.51%组及LNR>8.51%组患者的5年生存率分别为81.63%和23.40%，两组之间的差异具有统计学意义（χ2=143.504，P < 0.001）。单因素预后分析显示术后T分期、N分期、LNR、阴性淋巴结数目与患者的生存预后均相关（均P < 0.05）。多因素预后分析显示术后N分期、LNR为生存预后的独立影响因素（均P < 0.05）。N2组及LNR>8.51%组接受术后辅助治疗的患者生存显著优于单纯手术组（χ2=12.609，P < 0.001；χ2=13.171，P < 0.001）。联合N分期及LNR进行分析，在LNR>8.51%组的N2期患者接受术后辅助治疗组生存显著优于单纯手术组（χ2=12.609，P < 0.001）。 结论 LNR可以协同N分期更好地提示预后并指导食管癌根治术后患者辅助治疗的选择。对N2期同时伴有高LNR的患者应该积极选择术后辅助治疗。 Abstract:Objective To analyze the predictive value of postoperative lymph node status for adjuvant therapy in esophageal cancer patients after radical resection. Methods The indexes related to postoperative lymph node of 354 patients with esophageal carcinoma, who underwent radical surgery during a period between January 2007 and December 2010, were retrospectively analyzed. Univariate analysis was performed by Log-rank test and multivariate analysis by a Cox regression model. Results The 1-, 3-and 5-year overall survival (OS) rates were 84.46%, 64.12% and 54.06%, respectively, and the median survival time was 86.49 months. The 5-year OS rate of N0, N1, N2 and N3 stage patients were 93.13%, 55.50%, 19.80% and 3.45%, respectively. And it is obviously different from each other in PN stage (χ2=225.161, P < 0.001). We used the cut-off value of LNR 8.51% which was obtained by ROC curve to divide the patients into two groups. The 5-year survival rates of the group with LNR ≤ 8.51% and the group with LNR>8.51% were 81.63% and 23.40%, respectively. There were significant differences between the two groups (χ2=143.504, P < 0.001). The results of univariate analysis showed that PT stage, PN stage, LNR and number of negative lymph nodes were significantly correlated with OS (all P < 0.05). Multivariate analysis showed that the PN stage and LNR were independent factors for OS (all P < 0.05). The patients in the PN2 and LNR >8.51% groups with adjuvant therapy showed a significantly better survival than those with surgery alone and without adjuvant therapy (χ2=12.609, P < 0.001; χ2=13.171, P < 0.001). The patients in the group with PN2 stage as well as LNR >8.51% who had undergone adjuvant therapy showed a significantly better survival than those with simple surgery and without adjuvant therapy (χ2=12.609, P < 0.001). Conclusions The combination of PN stage and LNR as a better factor for predicting the prognosis of patients with esophageal cancer after radical resection can predict the value of adjuvant therapy. The patients with PN2 stage and higher LNR should choose postoperative adjuvant therapy. -
Key words:
- esophageal cancer /
- surgery /
- lymph node status /
- adjuvant therapy /
- prognosis
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图 1 354例食管癌术后患者的生存曲线
A：不同N分期；B：以清扫总淋巴结数中位数15枚为界分为两组；C：以阴性淋巴结中位数13枚为界分为两组；D：以LNR的ROC曲线所得最佳界值8.51%为界分为两组
图 2 接受不同术后辅助治疗的患者生存曲线
A：N2期患者术后辅助治疗组和单纯手术组的生存曲线；B：N1期患者不同术后辅助治疗方案组的生存曲线；C：N2期患者不同术后辅助治疗方案组的生存曲线；D：LNR>8.51%的患者不同术后辅助治疗方案组的生存曲线
表 1 患者一般临床病理资料及单因素预后分析
表 2 食管癌术后患者总生存预后的Cox多因素分析
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[1] Bray F, Ferlay J, Soerjomataram I, et al. Global cancer statistics 2018:GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries[J]. CA Cancer J Clin, 2018, 68(6):394-424. http://cn.bing.com/academic/profile?id=72ddb2c2747f7f6244ee8ffc4ce98b19&encoded=0&v=paper_preview&mkt=zh-cn [2] Li CL, Zhang Fl, Wang YD, et al. Characteristics of recurrence after radical esophagectomy with two-field lymph node dissection for thoracic esophageal cancer[J]. Oncol Lett, 2013, 5(1):355-359. http://www.wanfangdata.com.cn/details/detail.do?_type=perio&id=51e1803e290a8ac6b2d80c85f7344ffe [3] Smit JK, Pultrum BB, van Dullemen HM, et al. Prognostic factors and patterns of recurrence in esophageal cancer assert arguments for extended two-field transthoracic esophagectomy[J]. Am J Surg, 2010, 200(4):446-453. doi: 10.1016-j.amjsurg.2009.12.006/ [4] 宋春洋, 李腾, 赵彦, 等.ⅡB-Ⅲ期食管癌根治术后预防性放疗疗效分析[J].肿瘤防治研究, 2018, 45(6):404-409. http://d.old.wanfangdata.com.cn/Periodical/zlfzyj201806012 [5] Ohashi S, Miyamoto S, Kikuchi O, et al. Recent advances from basic and clinical studies of esophageal squamous cell carcinoma[J]. Gastroenterol, 2015, 149(7):1700-1715. http://www.wanfangdata.com.cn/details/detail.do?_type=perio&id=fb2d2a832ab868c32327e94b2a1a8c7c [6] Schreiber D, Rineer J, Dan Vongtama, et al. Impact of postoperative radiation after esophagectomy for esophageal cancer[J]. J Thorac Oncol, 2010, 5(2):244-250. doi: 10.1097-JTO.0b013e3181c5e34f/ [7] Guo X, Mao T, Gu ZT, et al. Clinical study on postoperative recurrence in patients with pN1 esophageal squamous cell carcinoma[J]. Thorac Cancer, 2015, 6(2):146-150. http://cn.bing.com/academic/profile?id=d920913930400780ef26feeba8cf4149&encoded=0&v=paper_preview&mkt=zh-cn [8] Qin RQ, Wen YS, Wang WP, et al. The role of postoperative adjuvant chemotherapy for lymph node-positive esophageal squamous cell carcinoma:a propensity score-matching analysis[J]. Med Oncol, 2016, 33(4):31. http://www.wanfangdata.com.cn/details/detail.do?_type=perio&id=10.1177/0272989X04274093 [9] Edge SB, Compton CC. The american joint committee on cancer:the 7th edition of the ajcc cancer staging manual and the future of TNM[J]. Ann Surg Oncol, 2010, 17(6):1471-1474. doi: 10.1245-s10434-010-0985-4/ [10] Kwon TS, Choi SB, Lee YS, et al. Novel methods of lymph node evaluation for predicting the prognosis of colorectal cancer patients with inadequate lymph node harvest[J]. Cancer Res Treat, 2016, 48(1):216-224. http://cn.bing.com/academic/profile?id=c9d6681e4c610bf3fbdf3fd086defed8&encoded=0&v=paper_preview&mkt=zh-cn [11] Liao GS, Chou YC, Golshan M, et al. Prognostic value of the lymph node ratio in breast cancer subtypes[J]. Am J Surg, 2015, 210(4):749-754. http://d.old.wanfangdata.com.cn/Periodical/zgjjssxzz201901001 [12] Sun GY, Xue L, Wang MD, et al. Lymph node ratio is a prognostic factor for non-small cell lung cancer[J]. Oncotarget, 2015, 6(32):33912-33918. http://cn.bing.com/academic/profile?id=e1a91a8740c3bbb36bc9451ab8547233&encoded=0&v=paper_preview&mkt=zh-cn [13] Birnbaum DJ, Viganò L, Russolillo N, et al. Lymph node metastases in patients undergoing surgery for a gallbladder cancer. Extension of the lymph node dissection and prognostic value of the lymph node ratio[J]. Ann Surg Oncol, 2015, 22(3):811-818. http://www.wanfangdata.com.cn/details/detail.do?_type=perio&id=edaa6176954e4314f5b01f2923db5e30 [14] Li YD, Zhao WX, Ni JJ, et al. Predicting the value of adjuvant therapy in esophageal squamous cell carcinoma by combining the total number of examined lymph nodes with the positive lymph node ratio[J]. Ann Surg Oncol, 2019, 26(8):2367-2374. http://cn.bing.com/academic/profile?id=12b1c203aec4a9c53904fb75075c5557&encoded=0&v=paper_preview&mkt=zh-cn [15] Zhang HD, Liang HG, Gao YY, et al. Metastatic lymph node ratio demonstrates better prognostic stratification than pN staging in patients with esophageal squamous cell carcinoma after esophagec-tomy[J]. Sci Rep, 2016, 6(1):38804. https://www.researchgate.net/publication/311769094_Metastatic_lymph_node_ratio_demonstrates_better_prognostic_stratification_than_pN_staging_in_patients_with_esophageal_squamous_cell_carcinoma_after_esophagectomy [16] Tan ZH, Ma GW, Yang HX, et al. Can lymph node ratio replace pN categories in the tumor-node-metastasis classification system for esophageal cancer[J]? J Thorac Oncol, 2014, 9(8):1214-1221. http://cn.bing.com/academic/profile?id=143025a27684318f73b442418859b22e&encoded=0&v=paper_preview&mkt=zh-cn [17] Qin RQ, Wen YS, Wang WP, et al. The role of postoperative adjuvant chemotherapy for lymph node-positive esophageal squamous cell carcinoma:a propensity score matching analysis[J]. Med Oncol, 2016, 33(4):31. http://www.wanfangdata.com.cn/details/detail.do?_type=perio&id=10.1177/0272989X04274093 [18] 齐战, 王玉祥, 杨琼, 等.食管鳞癌术后病理淋巴结阳性患者的预后及其术后化疗的作用[J].中华肿瘤杂志, 2017, 39(8):628-634. http://d.old.wanfangdata.com.cn/Periodical/zhzl201708014 [19] Zhang WC, Liu X, Xiao ZF, et al. Postoperative intensity-modulated radiotherapy improved survival in lymph node-positive or stage Ⅲ thoracic esophageal squamous cell carcinoma[J]. Oncol Res Treat, 2015, 38(3):97-102. http://pubmed.cn/25792080 -
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