Value of positive lymph node metastasis region in predicting postoperative recurrence for patients with esophageal squamous cell carcinoma after two-field esophagectomy
Wang Yuxiang, Yang Qiong, He Ming, Oiu Rong, Qi Zhan, Yang Jie, Zhu Shuchai, Qiao Xueying
Department of Radiation Oncology (Wang YX,Yang Q,Oiu R,Li J,Yang J,Zhu SC,Qiao XY),Department of Thoracic Surgery (He M,Qi Z),Fourth Hospital of Hebei Medical University,Shijiazhuang 050011,China
Abstract：Objective The recurrence rate is alarmingly high in patients with positive lymph node metastasis (pN＋) esophageal squamous cell carcinoma (ESCC) after two-field surgery. This study aims to retrospectively evaluate the value of pN＋ region in predicting postoperative recurrence in patients with pN＋ thoracic ESCC after two-field radical esophagectomy. Methods A total of 329 patients with pN＋ thoracic ESCC after two-field R0 esophagectomy were enrolled in this study. After surgery,pN＋ region was located at the upper abdomen in 116 patients,mediastinum in 119 and upper abdomen plus mediastinum in 94, respectively. The enumeration data were analyzed by chi-square test. Logistic multivariate regression analysis was performed to evaluate the risk factors of postoperative recurrence. Cumulative recurrence rate was statistically analyzed by using Kaplan-Meier method, Log-rank test and Cox model multivariate analysis. Results The overall recurrence rate was 72.4%(239/329).The overall locoregional recurrence (LR) rate was 58.1%(139/329) including 14.6% in the neck,42.9% in the mediastinum and 10.0% in the upper abdomen. Multivariate logistic and Cox regression analyses demonstrated that pN＋ region was the only independent factor affecting the overall recurrence and LR rates (both P<0.05).The overall recurrence and LR rates were 57.8% and 44.0% for patients with pN＋ region in the upper abdomen,77.3% and 62.3% for those with pN＋ region in the mediastinum and 85.1% and 72.3% for their counterparts with pN＋ region in the upper abdomen and mediastinum,respectively. Additionally pN＋ region was also the independent factor of the recurrence in the mediastinum or upper abdomen (both P<0.05) rather than the neck (P>0.05).The recurrence rates in the mediastimun and upper abomen were 27.6% and 12.9% for patients with pN＋ region in upper abdomen,47.1% and 4.2% for those with pN＋ region in the mediastinum,and 56.4% and 13.8% for patients with pN＋ region in the upper-abdomen plus mediastinum,respectively. Conclusions LR is the main cause of failure in patients with pN＋ thoracic ESCC after two-field R0 surgery.pN＋ region can be utilized to predict the overall recurrence and LR rates,especially for patients with postoperative recurrence in the the mediastinum and upper abdomen. The findings in this investigation contribute to the design of the target volume of postoperative adjuvant radiotherapy.
. Value of positive lymph node metastasis region in predicting postoperative recurrence for patients with esophageal squamous cell carcinoma after two-field esophagectomy[J]. Chinese Journal of Radiation Oncology, 2018, 27(5): 455-462.
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