胸中段食管鳞癌根治术后腹腔淋巴结复发因素分析及术后放疗指导意义

doi:10.3760/cma.j.issn.1004-4221.2018.02.003

Abstract
Figure/Table
References()
Related Citation (15)
Read Tracking
Download Tracking

Download: PDF (0 KB) HTML (1 KB)
Export: BibTeX | EndNote (RIS) Supporting Info

Abstract Objective To analyze the risk factors for abdominal lymph node recurrence after radical surgery in patients with middle thoracic esophageal squamous cell carcinoma (TE-SCC), and to design the target volume for postoperative radiotherapy based on the Results. Methods A retrospective study was performed among 913 patients with middle TE-SCC undergoing radical surgery who were admitted to our hospital from 2007 to 2012. Influencing factors were analyzed for abdominal lymph node recurrence after treatment. The efficacy was compared between different treatment Methods in the high-risk population. Comparison of categorical data was made by chi-square test. The overall survival rates (OS) were calculated by the Kaplan-Meier method and analyzed by the univariate log-rank analysis. The influencing factors for abdominal lymph node recurrence were analyzed by the multivariate logistic regression equation. Results After treatment, 37 patients had abdominal lymph node recurrence, yielding a recurrence rate of 4.1%. A total of 53 recurrent sites were found. The univariate analysis showed that no/low differentiation, pT3+4 stage, no less than 3 positive postoperative lymph nodes, and positive postoperative abdominal lymph nodes were influencing factors for abdominal lymph node recurrence (P=0.032,0.001,0.009,0.000). The multivariate regression analysis showed that pathological T staging and positive postoperative abdominal lymph nodes were influencing factors for abdominal lymph node recurrence (P=0.011, 0.000). For patients with pT3+4 stage disease and positive postoperative abdominal lymph nodes, postoperative radiotherapy improved OS and local control rates but failed to reduce the distant metastasis-free rate. Conclusions T staging and positive postoperative abdominal lymph nodes are important risk factors for abdominal lymph node recurrence after radical surgery in patients with middle TE-SCC. Postoperative adjuvant therapy is recommended for patients with pT3+4 stage disease and positive postoperative abdominal lymph nodes.

	Service

	E-mail this article
	Add to my bookshelf
	Add to citation manager
	E-mail Alert
	RSS
	Articles by authors
	Shen Wenbin
	Gao Hongmei
	Zhu Shuchai
	Li Teng
	Li Shuguang
	Li Youmei
	Liu Zhikun
	Su Jingwei
	Li Juan
	Xu Jinrui

Key words： Esophageal neoplasms/surgery Neoplasms recurrence,abdominal lymph node Postoperative target area

Received: 19 May 2017

Corresponding Authors: Zhu Shuchai,Email:sczhu1965@163.com

Cite this article:

Shen Wenbin,Gao Hongmei,Zhu Shuchai et al. Abdominal lymph node recurrence after radical surgery in patients with middle thoracic esophageal squamous cell carcinoma:risk factors and guidance for postoperative radiotherapy[J]. Chinese Journal of Radiation Oncology, 2018, 27(2): 135-139.

URL:

http://journal12.magtechjournal.com/Jweb_fszlx/EN/10.3760/cma.j.issn.1004-4221.2018.02.003 OR http://journal12.magtechjournal.com/Jweb_fszlx/EN/Y2018/V27/I2/135

[1] Chen JQ,Liu SY,Pan JJ,et al. The pattern and prevalence of lymphatic spread in thoracic oesophageal squamous cell carcinoma[J].Eur J Cardiothorac Surg,2009,36(3):480-486.DOI:10.1016/j.ejcts.2009.03.056.
[2] Cai WJ,Xin PL.Pattern of relapse in surgical treated patients with thoracic esophageal squamous cell carcinoma and its possible impact on target delineation for postoperative radiotherapy[J].Radiother Oncol,2010,96(1):104-107.DOI:10.1016/j.radonc.2010.04.029.
[3] Xiao ZF,Yang ZY,Miao YJ,et al. Influence of number of metastatic lymph nodes on survival of curative resected thoracic esophageal cancer patients and value of radiotherapy:report of 549 cases[J].Int J Radiat Oncol Biol Phys,2005,62(1):82-90.DOI:10.1016/j.ijrobp.2004.08.046.
[4] 陈跃军,邹求益,朱广,等.胸段食管癌淋巴结转移特点的临床研究[J].中华胃肠外科杂志,2013,16(9):835-837.DOI:10.3760/cma.j.issn.1671-0274.2013.09.009.Chen YJ,Zou QY,Zhu G,et al. Clinical study of the characteristics of lymph node metastasis in thoracic esophageal cancer[J].Chin J Gastrointest Surg,2013,16(9):835-837.DOI:10.3760/cma.j.issn.1671-0274.2013.09.009.
[5] 王军,张献波,祝淑钗,等.胸段食管癌淋巴结转移规律研究现状[J].中华放射肿瘤学杂志,2008,17(1):75-78.DOI:10.3321/j.issn:1004-4221.2008.01.023.Wang J,Zhang XB,Zhu SC,et al. Status of lymph node metastasis in thoracic esophageal carcinoma[J].Chin J Radiat Oncol,2008,17(1):75-78.DOI:10.3321/j.issn:1004-4221.2008.01.023.
[6] 陈俊强,陈明,林宇,等.食管癌根治术后腹腔淋巴结复发区域对术后放疗靶区确定的指导意义[J].中华放射肿瘤学杂志,2016,25(2):105-108.DOI:10.3760/cma.j.issn.1004-4221.2016.02.004.Chen JQ,Chen M,Lin Y,et al. Significance of regions of abdominal lymph node metastasis for target volume delineation in postoperative radiotherapy for patients with recurrent esophageal carcinoma after radical surgery[J].Chin J Radiat Oncol,2016,25(2):105-108.DOI:10.3760/cma.j.issn.1004-4221.2016.02.004.
[7] Doki Y,Ishikawa O,Takachi K,et al. Association of the primary tumor location with the site of tumor recurrence after curative resection of thoracic esophageal carcinoma[J].World J Surg,2005,29(6):700-707.DOI:10.1007/s00268-005-7596-4.
[8] 于舒飞,章文成,肖泽芬,等.胸中段淋巴结阳性食管癌术后放疗的临床意义[J].中华放射肿瘤学杂志,2016,25(4):332-338.DOI:10.3760/cma.j.issn.1004-4221.2016.04.007.Yu SF,Zhang WC,Xiao ZF,et al. Clinical value of postoperative radiotherapy for node-positive middle thoracic esophageal squamous cell carcinoma and modification of target volume[J].Chin J Radiat Oncol,2016,25(4):332-338.DOI:10.3760/cma.j.issn.1004-4221.2016.04.007.
[9] Chen JQ,Pan JJ,Zheng XW,et al. Number and location of positive nodes,postoperative radiotherapy,and survival after esophagectomy with three-field lymph node dissection for thoracic esophageal squamous cell carcinoma[J].Int J Radiat Oncol Biol Phys,2012,82(1):475-482.DOI:10.1016/j.ijrobp.2010.08.037.
[10] Chen JQ,Pan JJ,Liu J,et al. Postoperative radiation therapy with or without concurrent chemotherapy for node-positive thoracic esophageal squamous cell carcinoma[J].Int J Radiat Oncol Biol Phys,2013,86(4):671-677.DOI:10.1016/j.ijrobp.2013.03.026.
[11] Jiang YQ,Chen SF,Zhu B,et al. Prognostic factors and family history for survival of esophageal squamous cell carcinoma patients after surgery[J].Ann Thorac Surg,2010,90(3):908-913.DOI:10.1016/j.athoracsur.2010.05.060.
[12] Siewert JR,Stein HJ,Feith M,et al. Histologic tumor type is an independent prognostic parameter in esophageal cancer:lessons from more than 1,000 consecutive resections at a single center in the Western world[J].Ann Surg,2001,234(3):360-367.DOI:10.1097/00000658-200109000-00010.
[13] Endo M,Yoshino K,Kawano T,et al. Clinicopathologic analysis of lymph node metastasis in surgically resected superficial cancer of the thoracic esophagus[J].Dis Esophagus,2000,13(2):125-129.DOI:10.1046/j.1442-2050.2000.00100.x.
[14] Gotohda N,Nishimura M,Yoshida J,et al. The pattern of lymphatic metastases in superficial squamous cell carcinoma of the esophagus[J].Hepatogastroenterology,2005,52(61):105-107.
[15] 沈文斌,高红梅,祝淑钗,等.Ⅱ、Ⅲ期胸段食管鳞癌术后不同辅助治疗方式的疗效分析[J].中华放射肿瘤学杂志,2017,26(3):279-286.DOI:10.3760/cma.j.issn.1004-4221.2017.03.007.Shen WB,Gao HM,Zhu SC,et al. Efficacy of different postoperative adjuvant therapy strategies for stage Ⅱ/Ⅲ thoracic esophageal squamous cell carcinoma[J].Chin J Radiat Oncol,2017,26(3):279-286.DOI:10.3760/cma.j.issn.1004-4221.2017.03.007.
[16] 王玉祥,杨琼,何明,等.Ⅲ期胸段食管鳞癌根治术后的复发规律[J].中华肿瘤杂志,2017,39(1):48-55.DOI:10.3760/cma.j.issn.0253-3766.2017.01.010.Wang YX,Yang Q,He M,et al. Patterns of recurrence in patients with stage Ⅲ thoracic esophageal squamous cell carcinoma after radical resection[J].Chin J Oncol,2017,39(1):48-55.DOI:10.3760/cma.j.issn.0253-3766.2017.01.010.
[17] 沈文斌,高红梅,祝淑钗,等.pT3N0M0期胸段食管鳞癌患者术后失败原因分析及其术后放疗思考[J].中华放射肿瘤学杂志,2017,26(4):394-399.DOI:10.3760/cma.j.issn.1004-4221.2017.04.006.Shen WB,Gao HM,Zhu SC,et al. Analysis of postoperative failure in patients with stage pT3N0M0 thoracic esophageal squamous cell carcinoma and consideration of postoperative radiotherapy[J].Chin J Radiat Oncol,2017,26(4):394-399.DOI:10.3760/cma.j.issn.1004-4221.2017.04.006.
[18] 沈文斌,高红梅,祝淑钗,等.pN0期胸段食管鳞癌患者术后失败模式及其对术后放疗指导作用分析[J].中华放射医学与防护杂志,2017,37(3):199-204.DOI:10.3760/cma.j.issn.0254-5098.2017.03.007.Shen WB,Gao HM,Zhu SC,et al. Analysis of postoperative failure model in patients with stage pN0 esophageal squamous cell carcinoma and its effect on postoperative radiotherapy[J].Chin J Radiol Med Prot,2017,37(3):199-204.DOI:10.3760/cma.j.issn.0254-5098.2017.03.007.
[19] 杨琼,王玉祥,何明,等.影响Ⅲ期食管癌术后患者预后的因素[J].中华肿瘤杂志,2016,38(7):530-537.DOI:10.3760/cma.j.issn.0253-3766.2016.07.010.Yang Q,Wang YX,He M,et al. Factors affecting on long-time survival in patients with stage Ⅲ thoracic esophageal carcinoma after esophagectomy[J].Chin J Oncol,2016,38(7):530-537.DOI:10.3760/cma.j.issn.0253-3766.2016.07.010.