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Wu YP, Wu L, Ou J, Cao JM, Fu MY, Chen TW, Ouchi E, Hu J. Preoperative CT radiomics of esophageal squamous cell carcinoma and lymph node to predict nodal disease with a high diagnostic capability. Eur J Radiol 2024; 170:111197. [PMID: 37992611 DOI: 10.1016/j.ejrad.2023.111197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Revised: 10/12/2023] [Accepted: 11/13/2023] [Indexed: 11/24/2023]
Abstract
PURPOSE To develop CT radiomics models of resectable esophageal squamous cell carcinoma (ESCC) and lymph node (LN) to preoperatively identify LN+. MATERIALS AND METHODS 299 consecutive patients with ESCC were enrolled in the study, 140 of whom were LN+ and 159 were LN-. Of the 299 patients, 249 (from the same hospital) were randomly divided into a training cohort (n = 174) and a test cohort (n = 75). The remaining 50 patients, from a second hospital, were assigned to an external validation cohort. In the training cohort, preoperative contrast-enhanced CT radiomics features of ESCC and LN were extracted, then integrated with clinical features to develop three models: ESCC, LN and combined. The performance of these models was assessed using area under receiver operating characteristic curve (AUC), and F-1 score, which were validated in both the test cohort and external validation cohort. RESULTS An ESCC model was developed for the training cohort utilizing the 8 tumor radiomics features, and an LN model was constructed using 9 nodal radiomics features. A combined model was constructed using both ESCC and LN extracted features, in addition to cT stage and LN+ distribution. This combined model had the highest predictive ability among the three models in the training cohort (AUC = 0.948, F1-score = 0.878). The predictive ability was validated in both the test and external validation cohorts (AUC = 0.885 and 0.867, F1-score = 0.816 and 0.773, respectively). CONCLUSION To preoperatively determine LN+, the combined model is superior to models of ESCC and LN alone.
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Affiliation(s)
- Yu-Ping Wu
- Department of Radiology, the Second Affiliated Hospital of Chongqing Medical University, Chongqing, China; Medical Imaging Key Laboratory of Sichuan Province, and Department of Radiology, Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan, China
| | - Lan Wu
- Department of Radiology, the Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Jing Ou
- Medical Imaging Key Laboratory of Sichuan Province, and Department of Radiology, Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan, China
| | - Jin-Ming Cao
- Medical Imaging Key Laboratory of Sichuan Province, and Department of Radiology, Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan, China; Department of Radiology, Nanchong Central Hospital, The Second Clinical Medical College, North Sichuan Medical College, Nanchong, China
| | - Mao-Yong Fu
- Department of Thoracic Surgery, Affiliated Hospital of North Sichuan Medical College, Nanchong, China
| | - Tian-Wu Chen
- Department of Radiology, the Second Affiliated Hospital of Chongqing Medical University, Chongqing, China; Medical Imaging Key Laboratory of Sichuan Province, and Department of Radiology, Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan, China.
| | - Erika Ouchi
- Department of Radiology, Wayne State University, Detroit, MI, USA
| | - Jiani Hu
- Department of Radiology, Wayne State University, Detroit, MI, USA
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Wang XY, Fu XY, Yang H, Wen J, Lin P, Fu JH. Clinical value of station 4R node dissection in esophageal squamous cell carcinoma. World J Surg Oncol 2023; 21:387. [PMID: 38110961 PMCID: PMC10726609 DOI: 10.1186/s12957-023-03280-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Accepted: 12/09/2023] [Indexed: 12/20/2023] Open
Abstract
BACKGROUND Many controversies still exist concerning the optimal extent of lymphadenectomy during esophagectomy in esophageal squamous cell carcinoma (ESCC). The objective of this study was to explore the characteristics of 4R metastasis and evaluate the clinical value of 4R node dissection in ESCC. METHODS A total of 736 ESCC patients who underwent radical esophagectomy between 2005 and 2013 were retrospectively collected, among which 393 ones underwent 4R dissection. Propensity score matching (PSM) method was applied to reduce the effects of confounding variables between the 4R dissection and non-dissection groups to analyze overall survival. RESULTS Patients showed a low 4R metastasis rate of 5.1% (20/393) (5.2%, 5.8%, and 1.8% for upper, middle, and lower tumors, respectively). Correlation analyses identified that 4R metastasis was significantly associated with station 2R metastasis (p < 0.001) and pathologic tumor-node-metastasis (pTNM) stage (p < 0.001). All 4R metastases were observed in stages IIIB and IVA. Moreover, patients with station 4R dissection failed to achieve significantly improved overall survival compared with those without 4R dissection, regardless of tumor stage (overall: p = 0.696; stage 0-IIIA: p = 0.317; stage IIIB-IVA: p = 0.619). CONCLUSION 4R metastasis is likely to be associated with more aggressive disease, and routine 4R node dissection might not be necessary for ESCC patients.
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Affiliation(s)
- Xin-Ye Wang
- Department of Thoracic Surgery, Sun Yat-Sen University Cancer Center, 651 Dongfeng Road East, Guangzhou, 510060, China
- Guangdong Esophageal Cancer Institute, Collaborative Innovation Centre of Cancer Medicine, State Key Laboratory of Oncology in South China, Guangzhou, 510060, China
| | - Xia-Yu Fu
- Department of Thoracic Surgery, Sun Yat-Sen University Cancer Center, 651 Dongfeng Road East, Guangzhou, 510060, China
- Guangdong Esophageal Cancer Institute, Collaborative Innovation Centre of Cancer Medicine, State Key Laboratory of Oncology in South China, Guangzhou, 510060, China
| | - Hong Yang
- Department of Thoracic Surgery, Sun Yat-Sen University Cancer Center, 651 Dongfeng Road East, Guangzhou, 510060, China
- Guangdong Esophageal Cancer Institute, Collaborative Innovation Centre of Cancer Medicine, State Key Laboratory of Oncology in South China, Guangzhou, 510060, China
| | - Jing Wen
- Department of Thoracic Surgery, Sun Yat-Sen University Cancer Center, 651 Dongfeng Road East, Guangzhou, 510060, China
- Guangdong Esophageal Cancer Institute, Collaborative Innovation Centre of Cancer Medicine, State Key Laboratory of Oncology in South China, Guangzhou, 510060, China
| | - Peng Lin
- Department of Thoracic Surgery, Sun Yat-Sen University Cancer Center, 651 Dongfeng Road East, Guangzhou, 510060, China
- Guangdong Esophageal Cancer Institute, Collaborative Innovation Centre of Cancer Medicine, State Key Laboratory of Oncology in South China, Guangzhou, 510060, China
| | - Jian-Hua Fu
- Department of Thoracic Surgery, Sun Yat-Sen University Cancer Center, 651 Dongfeng Road East, Guangzhou, 510060, China.
- Guangdong Esophageal Cancer Institute, Collaborative Innovation Centre of Cancer Medicine, State Key Laboratory of Oncology in South China, Guangzhou, 510060, China.
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Lin K, Li B, Sun Y, Hu H, Zhang Y, Xiang J, Chen H. Precise pattern of lymphatic spread of esophageal squamous cell carcinoma: results of 1074 patients with N1 disease. J Cancer Res Clin Oncol 2023; 149:15819-15825. [PMID: 37668800 DOI: 10.1007/s00432-023-05359-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Accepted: 08/27/2023] [Indexed: 09/06/2023]
Abstract
PURPOSE The route of lymphatic spread in esophageal cancer remains unclear. The present study aimed to determine the pattern of lymphatic metastasis in its early stages. METHODS The data were reviewed of 1074 patients who underwent curative esophagectomy for thoracic esophageal squamous cell carcinoma and metastasis in 1-2 lymph nodes between January 2015 and December 2021. The frequencies of lymph node metastasis were analyzed by the anatomic sites and regions involved. RESULTS Of the 1074 patients, 668 patients (62.2%) with one positive lymph node and 406 (37.8%) with two positive lymph nodes. Paracardial lymph nodes were the most frequently involved nodes (35.1%), followed by right thoracic recurrent nerve nodes (24.0%), middle thoracic paraesophageal nodes (14.7%), left thoracic recurrent nerve nodes (10.4%), subcarinal nodes (8.0%), lower thoracic paraesophageal nodes (7.8%), and upper thoracic paraesophageal nodes (5.7%). The frequency of lymph node metastasis in other sites was less than 3%. The majority of lymph node metastases occurred in the longitudinal direction to the perigastric (36.5%) and bilateral recurrent nerve regions (33.4%) and in the transverse direction to the paraesophageal region (27.7%). As the tumor location changed from the upper to the lower thoracic esophagus, the frequencies of lymph node metastasis decreased in the bilateral recurrent nerve region but increased in the perigastric region. CONCLUSION Bilateral recurrent nerve nodes, paraesophageal lymph nodes, and perigastric nodes were the most common sites of early lymph node metastasis. Esophageal squamous cell carcinoma involves more longitudinal than transverse lymph node metastases.
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Affiliation(s)
- Kailin Lin
- Department of Thoracic Surgery and State Key Laboratory of Genetic Engineering, Fudan University Shanghai Cancer Center, 270 Dong'an Rd, Shanghai, 20032, China
- Institute of Thoracic Oncology, Fudan University, Shanghai, 200032, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, China
| | - Bin Li
- Department of Thoracic Surgery and State Key Laboratory of Genetic Engineering, Fudan University Shanghai Cancer Center, 270 Dong'an Rd, Shanghai, 20032, China
- Institute of Thoracic Oncology, Fudan University, Shanghai, 200032, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, China
| | - Yihua Sun
- Department of Thoracic Surgery and State Key Laboratory of Genetic Engineering, Fudan University Shanghai Cancer Center, 270 Dong'an Rd, Shanghai, 20032, China
- Institute of Thoracic Oncology, Fudan University, Shanghai, 200032, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, China
| | - Hong Hu
- Department of Thoracic Surgery and State Key Laboratory of Genetic Engineering, Fudan University Shanghai Cancer Center, 270 Dong'an Rd, Shanghai, 20032, China
- Institute of Thoracic Oncology, Fudan University, Shanghai, 200032, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, China
| | - Yawei Zhang
- Department of Thoracic Surgery and State Key Laboratory of Genetic Engineering, Fudan University Shanghai Cancer Center, 270 Dong'an Rd, Shanghai, 20032, China
- Institute of Thoracic Oncology, Fudan University, Shanghai, 200032, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, China
| | - Jiaqing Xiang
- Department of Thoracic Surgery and State Key Laboratory of Genetic Engineering, Fudan University Shanghai Cancer Center, 270 Dong'an Rd, Shanghai, 20032, China
- Institute of Thoracic Oncology, Fudan University, Shanghai, 200032, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, China
| | - Haiquan Chen
- Department of Thoracic Surgery and State Key Laboratory of Genetic Engineering, Fudan University Shanghai Cancer Center, 270 Dong'an Rd, Shanghai, 20032, China.
- Institute of Thoracic Oncology, Fudan University, Shanghai, 200032, China.
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, China.
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Zhou Y, Chu L, Lu S, Chu X, Ni J, Li Y, Guo T, Yang X, Zhu Z. Caution against simultaneous integrated boost radiotherapy for upper thoracic esophageal squamous cell carcinoma: results from a single-arm phase II trial. Esophagus 2023; 20:713-721. [PMID: 37149827 DOI: 10.1007/s10388-023-01012-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Accepted: 05/02/2023] [Indexed: 05/08/2023]
Abstract
PURPOSE To explore the feasibility and safety of simultaneous integrated boost technology (SIB) with elective nodal irradiation (ENI) to the cervical and upper mediastinal lymph node (LN) regions in upper thoracic esophageal squamous cell carcinoma (ESCC). MATERIAL AND METHODS Patients with pathologically proven unresectable upper thoracic ESCC were assigned 50.4 Gy/28 fractions (F) to the clinical target volume (encompassing the ENI area of cervical and upper mediastinal LN regions) and a boost of 63 Gy/28 F to the gross tumor volume. Chemotherapy consisted of courses of concurrent cisplatin (20 mg/m2) and docetaxel (20 mg/m2) weekly for 6 weeks. The primary endpoint was toxicity. RESULTS Between Jan 2017 and Dec 2019, 28 patients were included. The median follow-up time for all patients was 24.6 months (range 1.9-53.5). Radiation-related acute toxicity included esophagitis, pneumonia and radiodermatitis, all of which were well managed and reversed. Late morbidity included esophageal ulcer, stenosis, fistula and pulmonary fibrosis. Grade III esophageal stenosis and fistula was seen in 11% (3/28) and 14% (4/28) patients, respectively. The cumulative incidence rate of late esophageal toxicity was 7.7%, 19.2% and 24.6% at 6, 12 and 18 months, respectively. There was significant difference of the occurrence of severe late esophageal toxicity among the different volume levels of the esophagus, and cervical and upper mediastinal LNs which received ≥ 63 Gy stratified by the tertiles (p = 0.014). CONCLUSIONS Despite the acceptably tolerated acute toxicity of SIB in concurrent CRT with ENI to the cervical and upper mediastinal LN regions for upper thoracic ESCC, the incidence of severe late esophageal toxicity was relatively high. Cautions are provided against easy clinical application of SIB (50.4 Gy/28F to the CTV, 63 Gy/28F to the GTV) in upper thoracic ESCC. Further exploration on dose optimization is warranted.
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Affiliation(s)
- Yue Zhou
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, 270 Dongan Road, Shanghai, 200032, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, China
- Shanghai Clinical Research Center for Radiation Oncology, Shanghai, 200032, China
- Shanghai Key Laboratory of Radiation Oncology, Shanghai, 200032, China
| | - Li Chu
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, 270 Dongan Road, Shanghai, 200032, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, China
- Shanghai Clinical Research Center for Radiation Oncology, Shanghai, 200032, China
- Shanghai Key Laboratory of Radiation Oncology, Shanghai, 200032, China
| | - Saiquan Lu
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, 270 Dongan Road, Shanghai, 200032, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, China
- Shanghai Clinical Research Center for Radiation Oncology, Shanghai, 200032, China
- Shanghai Key Laboratory of Radiation Oncology, Shanghai, 200032, China
| | - Xiao Chu
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, 270 Dongan Road, Shanghai, 200032, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, China
- Shanghai Clinical Research Center for Radiation Oncology, Shanghai, 200032, China
- Shanghai Key Laboratory of Radiation Oncology, Shanghai, 200032, China
| | - Jianjiao Ni
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, 270 Dongan Road, Shanghai, 200032, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, China
- Shanghai Clinical Research Center for Radiation Oncology, Shanghai, 200032, China
- Shanghai Key Laboratory of Radiation Oncology, Shanghai, 200032, China
| | - Yida Li
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, 270 Dongan Road, Shanghai, 200032, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, China
- Shanghai Clinical Research Center for Radiation Oncology, Shanghai, 200032, China
- Shanghai Key Laboratory of Radiation Oncology, Shanghai, 200032, China
| | - Tiantian Guo
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, 270 Dongan Road, Shanghai, 200032, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, China
- Shanghai Clinical Research Center for Radiation Oncology, Shanghai, 200032, China
- Shanghai Key Laboratory of Radiation Oncology, Shanghai, 200032, China
| | - Xi Yang
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, 270 Dongan Road, Shanghai, 200032, China.
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, China.
- Shanghai Clinical Research Center for Radiation Oncology, Shanghai, 200032, China.
- Shanghai Key Laboratory of Radiation Oncology, Shanghai, 200032, China.
| | - Zhengfei Zhu
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, 270 Dongan Road, Shanghai, 200032, China.
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, China.
- Shanghai Clinical Research Center for Radiation Oncology, Shanghai, 200032, China.
- Shanghai Key Laboratory of Radiation Oncology, Shanghai, 200032, China.
- Institute of Thoracic Oncology, Fudan University, 270 Dongan Road, Shanghai, 200032, China.
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Zhang Y, Zhang L, Li B, Ye T, Zhang Y, Yu Y, Ma Y, Sun Y, Xiang J, Li Y, Chen H. Machine learning to predict occult metastatic lymph nodes along the recurrent laryngeal nerves in thoracic esophageal squamous cell carcinoma. BMC Cancer 2023; 23:197. [PMID: 36864444 PMCID: PMC9979471 DOI: 10.1186/s12885-023-10670-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Accepted: 02/22/2023] [Indexed: 03/04/2023] Open
Abstract
PURPOSE Esophageal squamous cell carcinoma (ESCC) metastasizes in an unpredictable fashion to adjacent lymph nodes, including those along the recurrent laryngeal nerves (RLNs). This study is to apply machine learning (ML) for prediction of RLN node metastasis in ESCC. METHODS The dataset contained 3352 surgically treated ESCC patients whose RLN lymph nodes were removed and pathologically evaluated. Using their baseline and pathological features, ML models were established to predict RLN node metastasis on each side with or without the node status of the contralateral side. Models were trained to achieve at least 90% negative predictive value (NPV) in fivefold cross-validation. The importance of each feature was measured by the permutation score. RESULTS Tumor metastases were found in 17.0% RLN lymph nodes on the right and 10.8% on the left. In both tasks, the performance of each model was comparable, with a mean area under the curve ranging from 0.731 to 0.739 (without contralateral RLN node status) and from 0.744 to 0.748 (with contralateral status). All models showed approximately 90% NPV scores, suggesting proper generalizability. The pathology status of chest paraesophgeal nodes and tumor depth had the highest impacts on the risk of RLN node metastasis in both models. CONCLUSION This study demonstrated the feasibility of ML in predicting RLN node metastasis in ESCC. These models may potentially be used intraoperatively to spare RLN node dissection in low-risk patients, thereby minimizing adverse events associated with RLN injuries.
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Affiliation(s)
- Yiliang Zhang
- grid.452404.30000 0004 1808 0942Departments of Thoracic Surgery and State Key Laboratory of Genetic Engineering, Fudan University Shanghai Cancer Center, 270 Dong’an Road, Shanghai, 200032 China ,grid.8547.e0000 0001 0125 2443Institute of Thoracic Oncology, Fudan University, Shanghai, China ,grid.11841.3d0000 0004 0619 8943Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Longfu Zhang
- Department of Pulmonary Medicine, Shanghai Xuhui Central Hospital, Zhongshan-Xuhui Hospital, Fudan University, Shanghai, 200031 China
| | - Bin Li
- grid.452404.30000 0004 1808 0942Departments of Thoracic Surgery and State Key Laboratory of Genetic Engineering, Fudan University Shanghai Cancer Center, 270 Dong’an Road, Shanghai, 200032 China ,grid.8547.e0000 0001 0125 2443Institute of Thoracic Oncology, Fudan University, Shanghai, China ,grid.11841.3d0000 0004 0619 8943Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Ting Ye
- grid.452404.30000 0004 1808 0942Departments of Thoracic Surgery and State Key Laboratory of Genetic Engineering, Fudan University Shanghai Cancer Center, 270 Dong’an Road, Shanghai, 200032 China ,grid.8547.e0000 0001 0125 2443Institute of Thoracic Oncology, Fudan University, Shanghai, China ,grid.11841.3d0000 0004 0619 8943Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Yang Zhang
- grid.452404.30000 0004 1808 0942Departments of Thoracic Surgery and State Key Laboratory of Genetic Engineering, Fudan University Shanghai Cancer Center, 270 Dong’an Road, Shanghai, 200032 China ,grid.8547.e0000 0001 0125 2443Institute of Thoracic Oncology, Fudan University, Shanghai, China ,grid.11841.3d0000 0004 0619 8943Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Yongfu Yu
- grid.8547.e0000 0001 0125 2443Department of Biostatistics, School of Public Health, and The Key Laboratory of Public Health Safety of Ministry of Education, Fudan University, Shanghai, China
| | - Yuan Ma
- grid.510934.a0000 0005 0398 4153Chinese Institute for Brain Research, Beijing, China
| | - Yihua Sun
- grid.452404.30000 0004 1808 0942Departments of Thoracic Surgery and State Key Laboratory of Genetic Engineering, Fudan University Shanghai Cancer Center, 270 Dong’an Road, Shanghai, 200032 China ,grid.8547.e0000 0001 0125 2443Institute of Thoracic Oncology, Fudan University, Shanghai, China ,grid.11841.3d0000 0004 0619 8943Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Jiaqing Xiang
- grid.452404.30000 0004 1808 0942Departments of Thoracic Surgery and State Key Laboratory of Genetic Engineering, Fudan University Shanghai Cancer Center, 270 Dong’an Road, Shanghai, 200032 China ,grid.8547.e0000 0001 0125 2443Institute of Thoracic Oncology, Fudan University, Shanghai, China ,grid.11841.3d0000 0004 0619 8943Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Yike Li
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, 1211 Medical Center Dr, Nashville, TN, 37232, USA.
| | - Haiquan Chen
- Departments of Thoracic Surgery and State Key Laboratory of Genetic Engineering, Fudan University Shanghai Cancer Center, 270 Dong'an Road, Shanghai, 200032, China. .,Institute of Thoracic Oncology, Fudan University, Shanghai, China. .,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China.
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Hsu PK, Lee YY, Chuang LC, Wu YC. Lymph Node Dissection for Esophageal Squamous Cell Carcinoma. Thorac Surg Clin 2022; 32:497-510. [DOI: 10.1016/j.thorsurg.2022.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Zhang X, Fang X, Liu P, Liu D, Yang H, Zhao W, Su F, Zhao K. Treatment outcomes of 156 patients with cervical esophageal cancers treated with definitive radiation therapy- A single-institution experience of a rare cancer. Front Oncol 2022; 12:929583. [PMID: 36059689 PMCID: PMC9435437 DOI: 10.3389/fonc.2022.929583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Accepted: 07/15/2022] [Indexed: 11/13/2022] Open
Abstract
Purpose Esophageal cancer is the most prevalent malignant tumor. The incidence of cervical esophageal cancer is low and there are insufficient data on the efficacy of radical radiotherapy. The purpose of this study was to clarify the efficacy with radical IFI radiotherapy, to analyze the pattern of initial lymph node metastasis and recurrence under the new lymph node zoning of esophageal cancer. Methods We reviewed cervical esophageal cancer treated with radical radiotherapy. The inclusion criteria were diagnosis of esophageal cancer by pathology; receiving radical radiotherapy or chemoradiotherapy; tumor location in accordance with definition of cervical esophageal cancer. Three dimensional radiotherapy was used. The target area was IFI. Results 156 patients entered the final analysis. The proportion of no failure was 42.31%, local esophageal failure was 30.13%, in-field lymph node metastasis was 10.26%, out-field lymph node metastasis was 1.28% and distant organ metastasis was 23.72%, second primary tumor was 2.56%. The median OS and DFS was 49.0 months (35.27-62.73) and 31.0 months (14.47-47.53). The results of initial LN metastasis pattern analysis showed the supraclavicular and upper mediastinum were the main sites of cervical esophageal cancer metastasis. In patients with recurrent LN, the results showed that the cervical, supraclavicle, upper mediastinum and abdomen were the main sites of recurrence. Conclusion Our study is a retrospective study of a large sample of radical radiotherapy for cervical esophageal cancer. Failure in irradiation field is the main failure pattern. Concurrent radiotherapy and chemotherapy under IFI radiation is a considerable treatment option for cervical esophageal cancer.
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Affiliation(s)
- Xiaofei Zhang
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Xumeng Fang
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Peiyi Liu
- Department of Orthopedics, TongRen Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Di Liu
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Huanjun Yang
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Weixin Zhao
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
- *Correspondence: Kuaile Zhao, ; Fengtao Su, ; Weixin Zhao,
| | - Fengtao Su
- Cancer Institute, Fudan University Shanghai Cancer Center, Shanghai Medical College of Fudan University, Shanghai, China
- *Correspondence: Kuaile Zhao, ; Fengtao Su, ; Weixin Zhao,
| | - Kuaile Zhao
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
- *Correspondence: Kuaile Zhao, ; Fengtao Su, ; Weixin Zhao,
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Chu L, Liu S, Guo T, Zou L, Li B, Ni J, Yang X, Chu X, Liang F, Li Y, Sun Y, Li Q, Yin F, Li G, Zhu Z. Is Performance of Fluorine-18-fluorodeoxyglucose Positron Emission Tomography/Computed tomography (CT) or Contrast-enhanced CT Efficient Enough to Guide the Hilar Lymph Node Staging for Patients with Esophageal Squamous Cell Carcinoma? Front Oncol 2022; 12:814238. [PMID: 35280825 PMCID: PMC8914423 DOI: 10.3389/fonc.2022.814238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2021] [Accepted: 01/31/2022] [Indexed: 11/13/2022] Open
Abstract
Introduction We evaluated the diagnostic performance of fluorine-18-fluorodeoxyglucose (18F-FDG) positron emission tomography (PET)/computed tomography (CT) and contrast-enhanced CT in the detection of hilar lymph node metastasis (LNM) in esophageal squamous cell carcinoma (ESCC) to determine their value in guiding hilar lymph node staging and delineating radiation target volume. Methods Consecutive patients with ESCC who underwent both PET/CT and contrast-enhanced CT before radical lymphadenectomy and esophagectomy at our institution from September 2009 to November 2018 were enrolled. The sensitivity (SE), specificity (SP), positive predictive value (PPV), and negative predictive value (NPV) of FDG-PET/CT and contrast-enhanced CT for diagnosing hilar LNM were calculated. Results Of the 174 patients included, contrast-enhanced CT predicted nine positive cases, while PET/CT predicted one, and eight (4.6%) were identified as pathologically positive for their resected hilar lymph nodes. The SE, SP, PPV, and NPV of PET/CT and contrast-enhanced CT were 0.000, 0.994, 0.000, and 0.954; and 0.125, 0.952, 0.111, and 0.958, respectively. The specificity showed a significant difference (P=0.037). PET/CT is slightly more specific than contrast-enhanced CT. Conclusions PET/CT and contrast-enhanced CT may be useful tools for predicting the negativity of hilar LN status, but they are not recommended for guiding the hilar lymph node staging and the delineating of hilar LNM in radiotherapy planning of ESCC patients based on their low PPV.
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Affiliation(s)
- Li Chu
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, China
- Institute of Thoracic Oncology, Fudan University, Shanghai, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
- Shanghai Key Laboratory of Radiation Oncology, Shanghai, China
| | - Shuai Liu
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
- Department of Nuclear Medicine, Fudan University Shanghai Cancer Center, Shanghai, China
| | - Tiantian Guo
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
- Shanghai Key Laboratory of Radiation Oncology, Shanghai, China
| | - Liqing Zou
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
- Shanghai Key Laboratory of Radiation Oncology, Shanghai, China
| | - Bin Li
- Institute of Thoracic Oncology, Fudan University, Shanghai, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
- Department of Thoracic Surgery, Fudan University Shanghai Cancer Center, Shanghai, China
| | - Jianjiao Ni
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, China
- Institute of Thoracic Oncology, Fudan University, Shanghai, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
- Shanghai Key Laboratory of Radiation Oncology, Shanghai, China
| | - Xi Yang
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, China
- Institute of Thoracic Oncology, Fudan University, Shanghai, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
- Shanghai Key Laboratory of Radiation Oncology, Shanghai, China
| | - Xiao Chu
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, China
- Institute of Thoracic Oncology, Fudan University, Shanghai, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
- Shanghai Key Laboratory of Radiation Oncology, Shanghai, China
| | - Fei Liang
- Department of Biostatistics, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Yida Li
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
- Shanghai Key Laboratory of Radiation Oncology, Shanghai, China
| | - Yuyun Sun
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
- Department of Nuclear Medicine, Fudan University Shanghai Cancer Center, Shanghai, China
| | - Qiao Li
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
- Department of Radiology, Fudan University Shanghai Cancer Center, Shanghai, China
| | - Fang Yin
- Center for Drug Clinical Research, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Guodong Li
- Institute of Thoracic Oncology, Fudan University, Shanghai, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
- Department of Interventional Radiology, Fudan University Shanghai Cancer Center, Shanghai, China
- *Correspondence: Zhengfei Zhu, ; Guodong Li,
| | - Zhengfei Zhu
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, China
- Institute of Thoracic Oncology, Fudan University, Shanghai, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
- Shanghai Key Laboratory of Radiation Oncology, Shanghai, China
- *Correspondence: Zhengfei Zhu, ; Guodong Li,
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9
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Huang Z, Jin Y, Cai X, Chen L, Shen X, Li B, Chen H, Li Y. Association of the programmed death ligand‐1 combined positive score in tumors and clinicopathological features in esophageal cancer. Thorac Cancer 2021; 13:523-532. [PMID: 34953041 PMCID: PMC8841709 DOI: 10.1111/1759-7714.14285] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Accepted: 12/06/2021] [Indexed: 01/12/2023] Open
Abstract
Background The combined positive score (CPS) of the programmed death ligand‐1 (PD‐L1) 22C3 assay is a predictive marker of pembrolizumab monotherapy for advanced esophageal cancer (EC) patients. However, little is known about the association of the PD‐L1 22C3 CPS with the clinicopathological features and heterogeneity of PD‐L1 expression in EC in the Chinese population in a real‐world setting. Methods We examined the association of the PD‐L1 22C3 CPS with clinicopathological characteristics in 533 EC specimens. Further, we compared 37 cases' different blocks of the same specimen and 50 paired primary/metastatic lymph node lesions to investigate the heterogeneity of PD‐L1 expression. Results PD‐L1 positive expression was observed in 45.0% of 533 EC patients, including 46.8% with squamous cell carcinoma, 15.4% with adenocarcinoma, 28.6% with basaloid squamous carcinoma, 42.9% with spindle cell carcinoma, and 33.3% with neuroendocrine tumors. PD‐L1 positive expression was positively associated with lymph node metastasis (59.2% chance, p = 0.021) and venous/lymphatic invasion (66.3% chance, p = 0.029). PD‐L1 expression was highly consistent in different paraffin blocks of the same surgically resected specimen (concordance rate: 86.5%, p = 0.000016) and a moderate consistency (concordance rate: 78.0%, p = 0.000373) for the primary and metastatic lymph node lesion comparison. Conclusions This is a novel study which demonstrated a positive correlation between a high PD‐L1 22C3 CPS and invasion/metastasis risk in EC surgical specimens. Both paired blocks and paired primary/metastatic lymph node lesions showed significant concordance. PD‐L1 heterogeneity was inferred to be mainly related to positive mononuclear inflammatory cells (MICs), which might have substantial implications for clinical practice.
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Affiliation(s)
- Ziling Huang
- Department of Pathology Fudan University Shanghai Cancer Center Shanghai China
- Department of Oncology Shanghai Medical College, Fudan University Shanghai China
| | - Yan Jin
- Department of Pathology Fudan University Shanghai Cancer Center Shanghai China
- Department of Oncology Shanghai Medical College, Fudan University Shanghai China
| | - Xu Cai
- Department of Pathology Fudan University Shanghai Cancer Center Shanghai China
- Department of Oncology Shanghai Medical College, Fudan University Shanghai China
| | - Lijun Chen
- Department of Pathology Fudan University Shanghai Cancer Center Shanghai China
- Department of Oncology Shanghai Medical College, Fudan University Shanghai China
| | - Xuxia Shen
- Department of Pathology Fudan University Shanghai Cancer Center Shanghai China
- Department of Oncology Shanghai Medical College, Fudan University Shanghai China
| | - Bin Li
- Department of Oncology Shanghai Medical College, Fudan University Shanghai China
- Department of Thoracic Surgery Fudan University Shanghai Cancer Center Shanghai China
| | - Haiquan Chen
- Department of Oncology Shanghai Medical College, Fudan University Shanghai China
- Department of Thoracic Surgery Fudan University Shanghai Cancer Center Shanghai China
| | - Yuan Li
- Department of Pathology Fudan University Shanghai Cancer Center Shanghai China
- Department of Oncology Shanghai Medical College, Fudan University Shanghai China
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10
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Wang H, Lin Z, Lin Y, Huang R, Qiu M, Peng X, He F, Huang L, Xiang Z, Lu W, Yan S, Liu S, Yang H, Zhang Z, Hu Z. Optimal Size Criterion for Malignant Lymph Nodes and a Novel Lymph Node Clinical Staging System for Unresectable Esophageal Squamous Cell Carcinoma: Evaluation by Multislice Spiral Computed Tomography. J Cancer 2021; 12:6454-6464. [PMID: 34659536 PMCID: PMC8489143 DOI: 10.7150/jca.61994] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2021] [Accepted: 08/18/2021] [Indexed: 11/05/2022] Open
Abstract
Objectives: The current Chinese draft nodal clinical staging system for unresectable esophageal cancer is controversial. Our study aimed to propose a new diagnostic criterion for lymph node metastasis (LNM) detected by multislice spiral computed tomography (MSCT) in nonsurgically treated esophageal squamous cell carcinoma (ESCC) patients and then develop a novel lymph node (LN) clinical staging system for better individual prognostic prediction. Methods: The short-axis diameters of regional LNs were measured in 393 nonsurgical patients. Regional nodes were considered positive for malignancy if the nodal size exceeded the optimal size, which was determined by Kaplan-Meier survival analysis. The novel LN clinical staging system was then constructed using the LASSO model based on the relative prognostic importance of different LN stations. Validation cohort was included to confirm the prognostic performance. Results: Regional nodes were considered positive for malignancy if they were larger than 10 mm in the low cervical and upper thoracic segments, 7 mm in the middle thoracic segment, and 8 mm in the lower thoracic and celiac segments. Using the LASSO model, stations 2R, 3A, 7 and 16 were qualified in the model. Further analysis showed that our LN clinical staging system had better homogeneity, discriminatory ability and clinical value than the draft nodal staging system. Conclusions: Our results show that the new diagnostic criterion may improve the diagnostic value of MSCT in metastatic LNs. The novel LN clinical staging system can stratify nonsurgically treated ESCC patients into different risk groups, providing valuable information for decision making and outcome prediction.
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Affiliation(s)
- Hang Wang
- Department of Epidemiology and Health Statistics, Fujian Provincial Key Laboratory of Environment factors and Cancer, School of Public Health, Fujian Medical University, Fuzhou, 350108, China.,Department of Disease Prevention and Healthcare, Fujian Provincial Hospital South Branch & Fujian Provincial Jinshan Hospital, Fuzhou, 350001, China
| | - Zheng Lin
- Department of Epidemiology and Health Statistics, Fujian Provincial Key Laboratory of Environment factors and Cancer, School of Public Health, Fujian Medical University, Fuzhou, 350108, China.,Key Laboratory of Ministry of Education for Gastrointestinal Cancer, Fujian Medical University, Fuzhou, 350108, China.,Fujian Digital Institute of Tumor Big Data, Fujian Medical University, Fuzhou, 350122, China
| | - Yimin Lin
- Department of Epidemiology and Health Statistics, Fujian Provincial Key Laboratory of Environment factors and Cancer, School of Public Health, Fujian Medical University, Fuzhou, 350108, China.,Fujian Center for ADR monitoring, Fujian Food and Drug Administration, Fuzhou, 350003, China
| | - Ruigang Huang
- Department of Imaging, Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou, 363000, China
| | - Moliang Qiu
- Department of Imaging, Affiliated Fuzhou First Hospital of Fujian Medical University, Fuzhou, 350009, China
| | - Xiane Peng
- Department of Epidemiology and Health Statistics, Fujian Provincial Key Laboratory of Environment factors and Cancer, School of Public Health, Fujian Medical University, Fuzhou, 350108, China.,Key Laboratory of Ministry of Education for Gastrointestinal Cancer, Fujian Medical University, Fuzhou, 350108, China.,Fujian Digital Institute of Tumor Big Data, Fujian Medical University, Fuzhou, 350122, China
| | - Fei He
- Department of Epidemiology and Health Statistics, Fujian Provincial Key Laboratory of Environment factors and Cancer, School of Public Health, Fujian Medical University, Fuzhou, 350108, China.,Key Laboratory of Ministry of Education for Gastrointestinal Cancer, Fujian Medical University, Fuzhou, 350108, China.,Fujian Digital Institute of Tumor Big Data, Fujian Medical University, Fuzhou, 350122, China
| | - Liping Huang
- Department of Epidemiology and Health Statistics, Fujian Provincial Key Laboratory of Environment factors and Cancer, School of Public Health, Fujian Medical University, Fuzhou, 350108, China
| | - Zhisheng Xiang
- Department of Epidemiology and Health Statistics, Fujian Provincial Key Laboratory of Environment factors and Cancer, School of Public Health, Fujian Medical University, Fuzhou, 350108, China
| | - Wanting Lu
- Department of Epidemiology and Health Statistics, Fujian Provincial Key Laboratory of Environment factors and Cancer, School of Public Health, Fujian Medical University, Fuzhou, 350108, China
| | - Siyou Yan
- Department of Epidemiology and Health Statistics, Fujian Provincial Key Laboratory of Environment factors and Cancer, School of Public Health, Fujian Medical University, Fuzhou, 350108, China
| | - Shuang Liu
- Department of Epidemiology and Health Statistics, Fujian Provincial Key Laboratory of Environment factors and Cancer, School of Public Health, Fujian Medical University, Fuzhou, 350108, China
| | - Huimin Yang
- Department of Epidemiology and Health Statistics, Fujian Provincial Key Laboratory of Environment factors and Cancer, School of Public Health, Fujian Medical University, Fuzhou, 350108, China
| | - Zhihui Zhang
- Department of Epidemiology and Health Statistics, Fujian Provincial Key Laboratory of Environment factors and Cancer, School of Public Health, Fujian Medical University, Fuzhou, 350108, China
| | - Zhijian Hu
- Department of Epidemiology and Health Statistics, Fujian Provincial Key Laboratory of Environment factors and Cancer, School of Public Health, Fujian Medical University, Fuzhou, 350108, China.,Key Laboratory of Ministry of Education for Gastrointestinal Cancer, Fujian Medical University, Fuzhou, 350108, China.,Fujian Digital Institute of Tumor Big Data, Fujian Medical University, Fuzhou, 350122, China
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11
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Wu Z, Zheng Q, Chen H, Xiang J, Hu H, Li H, Pan Y, Peng Y, Yao X, Liu P, Sun Y, Li B, Zhang Y. Efficacy and safety of neoadjuvant chemotherapy and immunotherapy in locally resectable advanced esophageal squamous cell carcinoma. J Thorac Dis 2021; 13:3518-3528. [PMID: 34277047 PMCID: PMC8264718 DOI: 10.21037/jtd-21-340] [Citation(s) in RCA: 51] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Accepted: 05/02/2021] [Indexed: 01/03/2023]
Abstract
Background Esophageal squamous cell cancer (ESCC) patients with the potentially resectable disease most would experience relapse after surgery. Immunotherapy has been reported to improve the prognosis of advanced esophageal cancer and may be a new strategy to prevent this urgent condition's recurrence. We first evaluated the efficacy and safety of neoadjuvant chemotherapy combined with immunotherapy in patients with resectable ESCC. Methods All patients with resectable locally advanced ESCC (clinical stage III-IVB). Received at least 1 cycle of neoadjuvant chemotherapy combined with immunotherapy (NACI), and the interval between each cycle and the operation should be at least 3 weeks. All patients were treated with standard surgery. The tumor imaginations were obtained at baseline and within a week before surgery. The efficacy endpoint was the rate of major pathologic response (MPR, 10% viable tumor cells). Expression of immunohistochemical-related molecules was investigated in surgical samples. Results A total of 38 patients with ESCC were included (36 males, median age 61 years), and most of them used Pembrolizumab (55.26%) and Camrelizumab (31.58%). We analyzed 19 patients and found that 13 patients (68.42%) achieved radiological partial response (PR) by CT images. R0 resection was performed in 35 patients (92.11%), and 10 patients (26.32%) developed postoperative complications. Through postoperative pathology, we found 13 (34.21%) patients had complete pathologic response (cPR), and 16 (42.11%) patients achieved MPR. We also found that none of the factors had a statistically significant impact on MPR. Still, the regression rate of Sum of lesion diameter (SLD) was significantly positively correlated with the pathological remission rate (P=0.012, r=0.565). Conclusions The rate of MPR in ESCC patients reached 42.11%. The use of the NACI regimen did not increase the occurrence of complications in neoadjuvant treatment and operation, and the SLD regression rate has a certain guiding significance for the effect of immunotherapy.
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Affiliation(s)
- Zhigang Wu
- Department of Thoracic Surgery, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Qiang Zheng
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China.,Department of Pathology, Fudan University Shanghai Cancer Center, Shanghai, China
| | - Haiquan Chen
- Department of Thoracic Surgery, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Jiaqing Xiang
- Department of Thoracic Surgery, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Hong Hu
- Department of Thoracic Surgery, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Hang Li
- Department of Thoracic Surgery, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Yunjian Pan
- Department of Thoracic Surgery, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Yizhou Peng
- Department of Thoracic Surgery, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Xingxin Yao
- Department of Thoracic Surgery, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Pengcheng Liu
- Department of Thoracic Surgery, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Yihua Sun
- Department of Thoracic Surgery, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Bin Li
- Department of Thoracic Surgery, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Yawei Zhang
- Department of Thoracic Surgery, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
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12
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Relative metabolic tumor burden is associated with residual lymph node status after neoadjuvant chemoradiotherapy in locally advanced esophageal cancer. Esophagus 2021; 18:211-218. [PMID: 32737800 DOI: 10.1007/s10388-020-00768-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Accepted: 07/27/2020] [Indexed: 02/08/2023]
Abstract
BACKGROUND Extended lymph node involvement could indicate limited survival benefit from neoadjuvant chemoradiotherapy with surgery in resectable locally advanced esophageal cancer. However, the threshold of node involvement is unclear. METHODS We retrospectively measured and calculated metabolic parameters derived from 18F-FDG PET/CT of the patients with nCRT and surgery. The parameters included metabolic tumor volume of the whole body (MTVwb), of the primary tumor (MTVp), of the lymph nodes (MTVn), and relative metabolic tumor burden (R-MTB, defined as the ratio of MTVwb and MTVp). RESULTS A total of 67 patients were enrolled in the study. The MTVp with thresholds as 3.0, 3.5, 4.0, 4.5 and 5.0 were significantly correlated with clinical T categories (Spearman's rank correlation coefficient, all P < 0.0001) and clinical tumor length categories (Spearman's rank correlation coefficient, all P ≤ 0.005). However, the MTVn were marginally correlated with clinical lymph node categories (P = 0.023). Among the 31 (31/67, 46.3%) patients with MTVn as 0 (R-MTB as 100.00%), 5 (5/5, 100.0%) were initially restaged as cLym- (MTVn as 0, R-MTB as 100.00%), while 26 (26/62, 41.9%) were initially restaged as cLym + (MTVn > 0, R-MTB > 100.00%). After nCRT, 43 (64.2%) patients achieved ypN0. The univariate and multivariate regression revealed that R-MTB (≤ 106.00% vs. > 106.00%) was an independent factor associated with ypN + status (OR 0.093, 95%CI 0.023-0.378, P = 0.001). CONCLUSION The preliminary study revealed a great heterogeneity in clinical lymph node categories in esophageal cancer. It suggested that R-MTB was significantly associated with ypN status after neoadjuvant chemoradiotherapy in locally advanced esophageal cancer. The findings with the indications needed to be further studied in a prospective study with a large patient cohort.
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13
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Qu R, Tu D, Ping W, Fu X. The Impact of the Recurrent Laryngeal Nerve Injury on Prognosis After McKeown Esophagectomy for ESCC. Cancer Manag Res 2021; 13:1861-1868. [PMID: 33658850 PMCID: PMC7917328 DOI: 10.2147/cmar.s298228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2020] [Accepted: 02/02/2021] [Indexed: 12/24/2022] Open
Abstract
Background The objective of this study was to assess the impact of the recurrent laryngeal nerve injury (RLNI) after esophagectomy on prognosis. Methods Retrospectively collected data from 297 patients with esophageal squamous cell carcinoma (ESCC) who underwent McKeown esophagectomy at our department from April 2014 to May 2018, were analyzed. Results RLNI occurred in 31.9% of the patients. Left-side RLNI occurred 2.8 times more often than right-side RLNI. Among the cases in which assessment of the vocal cords was continued, 8.4% involved permanent injury. There were no significant differences among clinicopathological data between patients with RLNI and without. Compared with patients without RLNI, patients with RNLI have longer operation time, more number of bronchoscopy suctions, longer postoperation hospital stay, and higher incidence of postoperative complications. T stage, N stage, RLN lymph node metastasis were independent risk factors for the prognosis, but RLNI is not independent risk factors for long-term survival. Conclusion RLNI is a serious complication that will affect the short-term prognosis of patients and reduce the quality of life of patients. It should be avoided as much as possible during surgery, but it may not have negative impact on the long-term survival.
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Affiliation(s)
- Rirong Qu
- Department of Thoracic Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, People's Republic of China
| | - Dehao Tu
- Department of Thoracic Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, People's Republic of China
| | - Wei Ping
- Department of Thoracic Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, People's Republic of China
| | - Xiangning Fu
- Department of Thoracic Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, People's Republic of China
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14
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Ye L, Zhou L, Wang S, Sun L, Wang J, Liu Q, Yang X, Chu L, Zhang X, Hu W, Lin J, Zhu Z. Para-aortic lymph node metastasis in lower Thoracic Esophageal Squamous Cell Carcinoma after Radical Esophagectomy: a CT-based atlas and its clinical implications for Adjuvant Radiotherapy. J Cancer 2021; 12:1734-1741. [PMID: 33613762 PMCID: PMC7890317 DOI: 10.7150/jca.51212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Accepted: 12/17/2020] [Indexed: 11/05/2022] Open
Abstract
Background: Our previous work showed that para-aortic lymph node (PALN) metastasis was the major failure pattern in lower thoracic esophageal squamous cell carcinoma (LTESCC) patients who presented abdominal LN failure after curative surgery. We thereby aim to generate a computerized tomography (CT)-based documentation of PALNs and to propose a clinical target volume (CTV) for this region. Methods: Sixty-five patients were enrolled. The epicentre of each PALN was drawn onto an axial CT image of a standard patient with reference to the surrounding anatomical landmarks. A CTV for PALN was generated based on the final result of node distribution, and was evaluated for dosimetric performance in three simulated patients. Results: All the studied 248 LNs were below the level of 1.0 cm above the celiac artery (CA), and 94.76% were above the bottom of vertebra L3. Horizontally, 93.33% of the LNs in the celiac level were located within an expansion of 1.5 cm on the CA, and 94.12% of the LNs in the superior mesenteric artery (SMA) level were within 1.5 cm on the left side of the SMA. Below the SMA, all the LNs were behind the left renal vein, left to the right border of the inferior vena cava, and 98.51% of the LNs were medial to the lateral surface of the left psoas major. The proposed CTV could cover 92.74% of the LNs and was dosimetrically feasible. Conclusions: The proposed CTV is the first one to focus on the high-risk area of abdominal failure in LTESCC patients after surgery and can serve as a reference in the adjuvant radiotherapy for LTESCC patients.
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Affiliation(s)
- Luxi Ye
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai 200032, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China
| | - Lijun Zhou
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai 200032, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China
| | - Shengping Wang
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China.,Department of Radiology, Fudan University Shanghai Cancer Center, Shanghai 200032, China
| | - Lining Sun
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai 200032, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China
| | - Jiazhou Wang
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai 200032, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China
| | - Quan Liu
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China.,Department of Radiology, Fudan University Shanghai Cancer Center, Shanghai 200032, China
| | - Xi Yang
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai 200032, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China
| | - Li Chu
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai 200032, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China
| | - Xiaofei Zhang
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai 200032, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China
| | - Weigang Hu
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai 200032, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China
| | - Jie Lin
- Department of Medical Oncology, the Second Affiliated Hospital of Kunming Medical University, Yunnan 650101, China
| | - Zhengfei Zhu
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai 200032, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China.,Institute of Thoracic Onology, Fudan University, Shanghai 200032, China
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15
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Zhao F, Lu RX, Liu JY, Fan J, Lin HR, Yang XY, You SH, Wu QG, Qin XY, Liu Y, Zhen FX, Luo JH, Wang W. Development and validation of nomograms to intraoperatively predict metastatic patterns in regional lymph nodes in patients diagnosed with esophageal cancer. BMC Cancer 2021; 21:22. [PMID: 33402129 PMCID: PMC7786479 DOI: 10.1186/s12885-020-07738-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2020] [Accepted: 12/15/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND An accurate intraoperative prediction of lymph node metastatic risk can help surgeons in choosing precise surgical procedures. We aimed to develop and validate nomograms to intraoperatively predict patterns of regional lymph node (LN) metastasis in patients with esophageal cancer. METHODS The prediction model was developed in a training cohort consisting of 487 patients diagnosed with esophageal cancer who underwent esophagectomy with complete LN dissection from January 2016 to December 2016. Univariate and multivariable logistic regression were used to identify independent risk factors that were incorporated into a prediction model and used to construct a nomogram. Contrast-enhanced computed tomography reported LN status and was an important comparative factor of clinical usefulness in a validation cohort. Nomogram performance was assessed in terms of calibration, discrimination, and clinical usefulness. An independent validation cohort comprised 206 consecutive patients from January 2017 to December 2017. RESULTS Univariate analysis and multivariable logistic regression revealed three independent predictors of metastatic regional LNs, three independent predictors of continuous regional LNs, and two independent predictors of skipping regional LNs. Independent predictors were used to build three individualized prediction nomograms. The models showed good calibration and discrimination, with area under the curve (AUC) values of 0.737, 0.738, and 0.707. Application of the nomogram in the validation cohort yielded good calibration and discrimination, with AUC values of 0.728, 0.668, and 0.657. Decision curve analysis demonstrated that the three nomograms were clinically useful in the validation cohort. CONCLUSION This study presents three nomograms that incorporate clinicopathologic factors, which can be used to facilitate the intraoperative prediction of metastatic regional LN patterns in patients with esophageal cancer.
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Affiliation(s)
- Fei Zhao
- Department of Thoracic Surgery, First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, China
| | - Rong-Xin Lu
- Department of Thoracic Surgery, First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, China
| | - Jin-Yuan Liu
- Department of Thoracic Surgery, First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, China
| | - Jun Fan
- Department of Thoracic Surgery, First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, China
| | - Hao-Ran Lin
- Department of Thoracic Surgery, First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, China
| | - Xiao-Yu Yang
- Department of Thoracic Surgery, First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, China
| | - Shu-Hui You
- Department of Thoracic Surgery, First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, China
| | - Qian-Ge Wu
- Department of Thoracic Surgery, First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, China
| | - Xue-Yun Qin
- Department of Thoracic Surgery, First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, China
| | - Yi Liu
- Department of Thoracic Surgery, First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, China
| | - Fu-Xi Zhen
- Department of Thoracic Surgery, First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, China.
| | - Jin-Hua Luo
- Department of Thoracic Surgery, First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, China.
| | - Wei Wang
- Department of Thoracic Surgery, First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, China.
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16
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Koemans WJ, Larue RTHM, Kloft M, Ruisch JE, Compter I, Riedl RG, Heij LR, van Elmpt W, Berbée M, Buijsen J, Lambin P, Sosef MN, Grabsch HI. Lymph node response to chemoradiotherapy in oesophageal cancer patients: relationship with radiotherapy fields. Esophagus 2021; 18:100-110. [PMID: 32889674 PMCID: PMC7794105 DOI: 10.1007/s10388-020-00777-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Accepted: 08/24/2020] [Indexed: 02/03/2023]
Abstract
BACKGROUND The presence of lymph node metastasis (LNmets) is a poor prognostic factor in oesophageal cancer (OeC) patients treated with neoadjuvant chemoradiotherapy (nCRT) followed by surgery. Tumour regression grade (TRG) in LNmets has been suggested as a predictor for survival. The aim of this study was to investigate whether TRG in LNmets is related to their location within the radiotherapy (RT) field. METHODS Histopathological TRG was retrospectively classified in 2565 lymph nodes (LNs) from 117 OeC patients treated with nCRT and surgery as: (A) no tumour, no signs of regression; (B) tumour without regression; (C) viable tumour and regression; and (D) complete response. Multivariate survival analysis was used to investigate the relationship between LN location within the RT field, pathological TRG of the LN and TRG of the primary tumour. RESULTS In 63 (54%) patients, viable tumour cells or signs of regression were seen in 264 (10.2%) LNs which were classified as TRG-B (n = 56), C (n = 104) or D (n = 104) LNs. 73% of B, C and D LNs were located within the RT field. There was a trend towards a relationship between LN response and anatomical LN location with respect to the RT field (p = 0.052). Multivariate analysis showed that only the presence of LNmets within the RT field with TRG-B is related to poor overall survival. CONCLUSION Patients have the best survival if all LNmets show tumour regression, even if LNmets are located outside the RT field. Response in LNmets to nCRT is heterogeneous which warrants further studies to better understand underlying mechanisms.
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Affiliation(s)
- Willem J. Koemans
- Department of Surgery, Zuyderland Medical Center, Heerlen/Sittard, The Netherlands ,grid.412966.e0000 0004 0480 1382Department of Pathology, GROW School for Oncology and Developmental Biology, Maastricht University Medical Center+, P. Debyelaan 25, 6229 HX Maastricht, The Netherlands ,grid.430814.aDepartment of Surgical Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Ruben T. H. M. Larue
- grid.412966.e0000 0004 0480 1382Department of Radiation Oncology (MAASTRO), GROW School for Oncology and Developmental Biology, Maastricht University Medical Center+, Maastricht, The Netherlands ,grid.412966.e0000 0004 0480 1382The D-Lab, Department of Precision Medicine, GROW School for Oncology and Developmental Biology, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - Maximilian Kloft
- grid.412966.e0000 0004 0480 1382Department of Pathology, GROW School for Oncology and Developmental Biology, Maastricht University Medical Center+, P. Debyelaan 25, 6229 HX Maastricht, The Netherlands
| | - Jessica E. Ruisch
- grid.412966.e0000 0004 0480 1382Department of Pathology, GROW School for Oncology and Developmental Biology, Maastricht University Medical Center+, P. Debyelaan 25, 6229 HX Maastricht, The Netherlands
| | - Inge Compter
- grid.412966.e0000 0004 0480 1382Department of Radiation Oncology (MAASTRO), GROW School for Oncology and Developmental Biology, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - Robert G. Riedl
- Department of Pathology, Zuyderland Medical Center, Heerlen/Sittard, The Netherlands
| | - Lara R. Heij
- grid.412301.50000 0000 8653 1507Department of General, Gastrointestinal, Hepatobiliary and Transplant Surgery, RWTH Aachen University Hospital, Aachen, Germany ,grid.412301.50000 0000 8653 1507Department of Pathology, RWTH Aachen University Hospital, Aachen, Germany
| | - Wouter van Elmpt
- grid.412966.e0000 0004 0480 1382Department of Radiation Oncology (MAASTRO), GROW School for Oncology and Developmental Biology, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - Maaike Berbée
- grid.412966.e0000 0004 0480 1382Department of Radiation Oncology (MAASTRO), GROW School for Oncology and Developmental Biology, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - Jeroen Buijsen
- grid.412966.e0000 0004 0480 1382Department of Radiation Oncology (MAASTRO), GROW School for Oncology and Developmental Biology, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - Philippe Lambin
- grid.412966.e0000 0004 0480 1382The D-Lab, Department of Precision Medicine, GROW School for Oncology and Developmental Biology, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - Meindert N. Sosef
- Department of Surgery, Zuyderland Medical Center, Heerlen/Sittard, The Netherlands
| | - Heike I. Grabsch
- grid.412966.e0000 0004 0480 1382Department of Pathology, GROW School for Oncology and Developmental Biology, Maastricht University Medical Center+, P. Debyelaan 25, 6229 HX Maastricht, The Netherlands ,grid.9909.90000 0004 1936 8403Pathology and Data Analytics, Leeds Institute of Medical Research at St James’s, University of Leeds, Leeds, UK
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Esophagectomy With Three-Field Versus Two-Field Lymphadenectomy for Middle and Lower Thoracic Esophageal Cancer: Long-Term Outcomes of a Randomized Clinical Trial. J Thorac Oncol 2020; 16:310-317. [PMID: 33307192 DOI: 10.1016/j.jtho.2020.10.157] [Citation(s) in RCA: 49] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Revised: 10/14/2020] [Accepted: 10/15/2020] [Indexed: 12/28/2022]
Abstract
INTRODUCTION The optimal extent of lymphadenectomy during esophagectomy remains unclear. In this trial, we aim to clarify whether three-field (cervical-thoracic-abdominal) lymphadenectomy improved patient survival over two-field (thoracic-abdominal) lymphadenectomy for esophageal cancer. METHODS Between March 2013 and November 2016, a total of 400 patients with middle and lower thoracic esophageal cancer were included and randomly assigned to undergo esophagectomy with either three- or two-field lymphadenectomy at a 1:1 ratio. Analyses were done according to the intention-to-treat principle. The primary end point was overall survival (OS), calculated from the date of randomization to the date of death from any cause. RESULTS Demographic characteristics were similar in the two arms. The median follow-up time was 55 months (95% confidence interval [CI]: 52-58). OS (hazard ratio [HR] = 1.019, 95% CI: 0.727-1.428, p = 0.912) and the disease-free survival (DFS) (HR = 0.868, 95% CI: 0.636-1.184, p = 0.371) were comparable between the two arms. The cumulative 5-year OS was 63% in the three-field arm, as compared with 63% in the two-field arm; 5-year DFS was 59% and 53%, respectively. On the basis of whether the patients had mediastinal or abdominal lymph node metastasis or not, OS was also comparable between the two arms. In this cohort, only advanced tumor stage (pathologic TNM stages III-IV) was identified as the risk factor associated with reduced OS (HR = 3.330, 95% CI: 2.140-5.183, p < 0.001). CONCLUSIONS For patients with middle and lower thoracic esophageal cancer, there was no improvement in OS or DFS after esophagectomy with three-field lymphadenectomy over two-field lymphadenectomy.
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Wang Z, Mao Y, Gao S, Li Y, Tan L, Daiko H, Liu S, Chen C, Koyanagi K, He J. Lymph node dissection and recurrent laryngeal nerve protection in minimally invasive esophagectomy. Ann N Y Acad Sci 2020; 1481:20-29. [PMID: 32671860 DOI: 10.1111/nyas.14427] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Revised: 05/29/2020] [Accepted: 06/16/2020] [Indexed: 12/16/2022]
Abstract
Until now, neoadjuvant therapy plus surgical resection of the primary tumor and potential metastatic lymph nodes (LNs) has been the current optimal treatment for locally advanced thoracic esophageal cancer (EC). LN metastasis is one of the most negative prognostic factors for thoracic esophageal squamous cell carcinoma (ESCC). However, the extent of LN dissection for thoracic ESCC has long been controversial worldwide. LNs along the recurrent laryngeal nerve (RLN) were reported to have the highest frequency of metastases in thoracic ESCC, so lymphadenectomy along the bilateral RLN is necessary but quite challenging because of a high frequency of recurrent nerve palsy and related postoperative complications. With the development of minimally invasive devices and techniques in recent years, minimally invasive esophagectomy (MIE) has been widely applied in EC surgery. The topics of what the optimal extent of lymphadenectomy is and how the recurrent nerve should be well protected during MIE have been debated in recent years. The purpose of our review is specifically to address the patterns of LN metastasis, the extent of LN dissection, and the protection of the RLN in MIE for thoracic ESCC.
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Affiliation(s)
- Zhen Wang
- Department of Thoracic Surgery, National Cancer Center, Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Yousheng Mao
- Department of Thoracic Surgery, National Cancer Center, Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Shugeng Gao
- Department of Thoracic Surgery, National Cancer Center, Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Yin Li
- Department of Thoracic Surgery, National Cancer Center, Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Lijie Tan
- Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Hiroyuki Daiko
- Esophageal Surgery Division, National Cancer Center Hospital, Tokyo, Japan
| | - Shuoyan Liu
- Department of Thoracic Surgery, Fujian Cancer Hospital & Fujian Medical University Cancer Hospital, Fuzhou, China
| | - Chun Chen
- Department of Thoracic Surgery, Fujian Medical University Union Hospital, Fuzhou, China
| | - Kazuo Koyanagi
- Department of Gastroenterological Surgery, Tokai University School of Medicine, Tokyo, Japan
| | - Jie He
- Department of Thoracic Surgery, National Cancer Center, Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
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Zhou Y, Du J, Wang Y, Li H, Ping G, Luo J, Chen L, Zhang S, Wang W. Prediction of lymph node metastatic status in superficial esophageal squamous cell carcinoma using an assessment model combining clinical characteristics and pathologic results: A retrospective cohort study. Int J Surg 2019; 66:53-61. [DOI: 10.1016/j.ijsu.2019.04.014] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2018] [Revised: 03/13/2019] [Accepted: 04/22/2019] [Indexed: 01/02/2023]
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20
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Li B, Hu H, Zhang Y, Zhang J, Sun Y, Xiang J, Chen H. Esophageal squamous cell carcinoma patients with positive lymph nodes benefit from extended radical lymphadenectomy. J Thorac Cardiovasc Surg 2019; 157:1275-1283.e1. [DOI: 10.1016/j.jtcvs.2018.11.094] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2018] [Revised: 10/26/2018] [Accepted: 11/10/2018] [Indexed: 01/01/2023]
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21
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Wang WP, Chen LQ. ASO Author Reflections: It is Essential to Explore More Accurate Nodal Staging System for Esophageal Cancer. Ann Surg Oncol 2019; 26:1012-1013. [PMID: 30693452 DOI: 10.1245/s10434-019-07197-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Indexed: 02/05/2023]
Affiliation(s)
- Wen-Ping Wang
- Department of Thoracic Surgery, West China Hospital of Sichuan University, Chengdu, China
| | - Long-Qi Chen
- Department of Thoracic Surgery, West China Hospital of Sichuan University, Chengdu, China.
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22
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Hu K, Kang N, Liu Y, Guo D, Jing W, Lu J, Tan T, Lv C, Deng Y, Long J, Wang R, Yu J. Proposed revision of N categories to the 8th edition of the AJCC-TNM staging system for non-surgical esophageal squamous cell cancer. Cancer Sci 2018; 110:717-725. [PMID: 30467921 PMCID: PMC6361553 DOI: 10.1111/cas.13891] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2018] [Revised: 10/17/2018] [Accepted: 11/19/2018] [Indexed: 02/06/2023] Open
Abstract
The 8th edition of the American Joint Committee on Cancer Tumor‐Node‐Metastasis (AJCC‐TNM) staging system for esophageal cancer (EC) retained the definition of N categories based on the number of metastatic lymph nodes (LN). However, it is difficult to accurately determine the number of metastatic LN without surgery. This study aimed to propose a revision to the N categories of the 8th edition AJCC‐TNM staging system that makes staging easier to perform and better represents the prognosis of non‐surgical esophageal squamous cell cancer (ESCC). We retrospectively reviewed the data of 336 patients with ESCC. The revised N categories were based on the anatomic regions of LN metastasis (cervix, thorax and abdomen). Survival was analyzed using the Kaplan‐Meier method and compared using the log‐rank test. Multivariate analyses were performed using the Cox proportional hazard model. Survival differences were adequately discriminated when the revised N categories were used. Subgroup analyses by T stage showed significant difference in overall survival between the revised N categories. Multivariate analyses demonstrated that T stage, revised N category, age, sex and treatment modality were independent risk factors, with the revised N category being the most significant variable. The revised N categories determined in this study can be used to fill gaps in the staging system for patients with non‐surgical ESCC, which can help clinicians to make better treatment decisions and more effectively predict patient prognoses. Future large‐scale studies are required to validate these results.
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Affiliation(s)
- Kai Hu
- School of Medicine, Shandong University, Jinan, Shandong, China.,Department of Radiation Oncology, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China.,Department of Radiation Oncology, Shandong Cancer Hospital Affiliated to Shandong University, Jinan, Shandong, China
| | - Ning Kang
- Department of Radiation Oncology, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China
| | - Yang Liu
- Department of Radiation Oncology, Shandong Cancer Hospital Affiliated to Shandong University, Jinan, Shandong, China.,School of Medicine and Life Sciences, University of Jinan-Shandong Academy of Medical Sciences, Jinan, Shandong, China
| | - Dong Guo
- Department of Radiation Oncology, Shandong Cancer Hospital Affiliated to Shandong University, Jinan, Shandong, China.,Weifang Medical University, Weifang, Shandong, China
| | - Wang Jing
- Department of Radiation Oncology, Shandong Cancer Hospital Affiliated to Shandong University, Jinan, Shandong, China
| | - Jiamei Lu
- Department of Radiation Oncology, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China
| | - Tianmeng Tan
- Pre-Clinical Faculty of Guangxi Medical University, Nanning, Guangxi, China
| | - Caitiao Lv
- Pre-Clinical Faculty of Guangxi Medical University, Nanning, Guangxi, China
| | - Yuyan Deng
- Pre-Clinical Faculty of Guangxi Medical University, Nanning, Guangxi, China
| | - Jianxiong Long
- School of Public Health of Guangxi Medical University, Nanning, Guangxi, China
| | - Rensheng Wang
- Department of Radiation Oncology, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China
| | - Jinming Yu
- School of Medicine, Shandong University, Jinan, Shandong, China.,Department of Radiation Oncology, Shandong Cancer Hospital Affiliated to Shandong University, Jinan, Shandong, China
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23
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Li ZG, Zhang XB, Wen YW, Liu YH, Chao YK. Incidence and Predictors of Unsuspected Recurrent Laryngeal Nerve Lymph Node Metastases After Neoadjuvant Chemoradiotherapy in Patients with Esophageal Squamous Cell Carcinoma. World J Surg 2018; 42:2485-2492. [PMID: 29380005 DOI: 10.1007/s00268-018-4516-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
BACKGROUND Radical lymph node (LN) dissection along the recurrent laryngeal nerve (RLN) area carries a substantial morbidity rate, and its usefulness in neoadjuvant chemoradiotherapy (nCRT)-treated esophageal cancer patients remains unclear. METHODS This study was conducted in two Asian thoracic surgery centers. Patients with esophageal squamous cell carcinoma (ESCC) who were judged to be ycN-RLN(-) after nCRT and received bilateral RLN LN dissection were eligible. The incidence of unsuspected RLN LN involvement was analyzed, and we used least absolute shrinkage and selection operator (LASSO) regression to identify its predictors. RESULTS A total of 56 patients (53 males and 3 females; mean age: 55 years) were included. The upper mediastinum-including the bilateral RLN area-was covered by the radiation field in 48 (85.3%) patients. Although all of them were judged as ycN-RLN(-), unsuspected RLN LN involvement was identified on pathological examination in 11 (19.6%) subjects, being the only positive nodal station in seven. LASSO regression identified the pre-nCRT RLN LN(cN-RLN) status as the only independent predictor of ypN-RLN positivity; in contrast, neither the tumor location nor the radiation dose to the upper mediastinum were independently associated with ypN-RLN(+). RLN nodal dissection resulted in positive LN discovery rates of 30.8 and 10% in ycN-RLN(-) patients who had positive and negative cN-RLNs before nCRT, respectively. Consequently, 23.1 and 6.7% of patients in each subgroup would have been understaged in the absence of RLN nodal dissection. CONCLUSION Nearly one-fifth of ESCC patients who were judged to be ycN-RLN(-) unexpectedly had positive ypN-RLN. The pre-nCRT cN-RLN status plays a key role in the selection of patients that should undergo RLN LN dissection after nCRT.
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Affiliation(s)
- Zhi-Gang Li
- Division of Thoracic Surgery, Shanghai Chest Hospital, Shanghai, China
| | - Xiao-Bin Zhang
- Division of Thoracic Surgery, Shanghai Chest Hospital, Shanghai, China
| | - Yu-Wen Wen
- Division of Thoracic Surgery, Chang Gung Memorial Hospital-Linkou, College of Medicine, Chang Gung University, Taoyuan, Taiwan.,Clinical Informatics and Medical Statistics Research Center, Chang Gung University, Taoyuan, Taiwan
| | - Yun-Hen Liu
- Division of Thoracic Surgery, Chang Gung Memorial Hospital-Linkou, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Yin-Kai Chao
- Division of Thoracic Surgery, Chang Gung Memorial Hospital-Linkou, College of Medicine, Chang Gung University, Taoyuan, Taiwan.
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Zhang J, Liu Y, Che F, Luo Y, Huang W, Heng X, Li B. Pattern of lymph node metastasis in thoracic esophageal squamous cell carcinoma with poor differentiation. Mol Clin Oncol 2018; 8:760-766. [PMID: 29844907 DOI: 10.3892/mco.2018.1606] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2018] [Accepted: 03/28/2018] [Indexed: 12/14/2022] Open
Abstract
The aim of the present study was to explore the pattern of lymph node metastasis (LNM) in poorly-differentiated esophageal squamous cell carcinoma (pdESCC) and the implication of postoperative irradiation. A total of 690 patients with pdESCC were retrospectively investigated. The rates of intro-thoracic and extra-thoracic LNM in pdESCC were investigated and compared to previous research on ESCC en bloc. The comparison of the rates between pdESCC and ESCC were performed using the Cochran-Mantel-Haenszel test. The clinicopathological factors associated with LNM in pdESCC were analyzed by Chi-squared tests, and Fisher's exact test was used to assess the rate difference of extra-thoracic LNM. Logistic-regression analysis was used to explore risk factors associated with lymph node (LN) station. Results demonstrated that the distribution pattern of LNM in pdESCC was significantly different compared with that of ESCC (P<0.05). Univariate and multivariate analysis indicated that risk factors associated with LNM were depth and length (P<0.001 and P<0.001) and multivariate analysis also indicated that the location of the tumor (P=0.042) was a risk factor associated with LNM in pdESCC. Metastasis in the abdominal cavity was significantly higher than in the neck in the middle and lower thoracic pdESCC (both P<0.01). LN station 102 and 7 for upper thoracic ESCC, 101 and 105 for middle thoracic ESCC, and 100 for lower thoracic ESCC were identified as high-risk stations for metastases in pdESCC compared to ESCC. Several parameters, including location and neck metastasis, were identified as risk factors of metastasis for the above sites, respectively. In conclusion, postoperative therapy should include more LN stations in pdESCC depending on risk factors of tumor metastasis individually.
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Affiliation(s)
- Jinling Zhang
- Cancer Center, Linyi People's Hospital Affiliated to Shandong University, Linyi, Shandong 276000, P.R. China
| | - Yuanyuan Liu
- Cancer Center and Steering Committee, Linyi People's Hospital Affiliated to Shandong University, Linyi, Shandong 276000, P.R. China
| | - Fengyuan Che
- Cancer Center, Linyi People's Hospital Affiliated to Shandong University, Linyi, Shandong 276000, P.R. China
| | - Yi Luo
- Department of Radiation Oncology, University of Michigan, Ann Arbor, MI 48105, USA
| | - Wei Huang
- Department of Radiation Oncology (Chest Section), Shandong Key Laboratory of Radiation Oncology, Shandong Cancer Hospital, Shandong Academy of Medical Sciences, Shandong University, Jinan, Shandong 250117, P.R. China
| | - Xueyuan Heng
- Cancer Center, Linyi People's Hospital Affiliated to Shandong University, Linyi, Shandong 276000, P.R. China
| | - Baosheng Li
- Department of Radiation Oncology (Chest Section), Shandong Key Laboratory of Radiation Oncology, Shandong Cancer Hospital, Shandong Academy of Medical Sciences, Shandong University, Jinan, Shandong 250117, P.R. China
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25
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Li H, Fang W, Yu Z, Mao Y, Chen L, He J, Rong T, Chen C, Chen H, Chen K, Du M, Han Y, Hu J, Fu J, Hou X, Gong T, Li Y, Liu J, Liu S, Tan L, Tian H, Wang Q, Xiang J, Xu M, Ye X, You B, Zhang R, Zhao Y. Chinese expert consensus on mediastinal lymph node dissection in esophagectomy for esophageal cancer (2017 edition). J Thorac Dis 2018; 10:2481-2489. [PMID: 29850156 DOI: 10.21037/jtd.2018.03.175] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Affiliation(s)
- Hui Li
- Department of Thoracic Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing 100020, China
| | - Wentao Fang
- Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiaotong University Medical School, Shanghai 200030, China
| | - Zhentao Yu
- Department of Esophageal Oncology, Tianjin Medical University Cancer Institute & Hospital, Tianjin 300060, China
| | - Yousheng Mao
- Department of Thoracic Surgery, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021,China
| | - Longqi Chen
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Jie He
- Department of Thoracic Surgery, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Tiehua Rong
- Department of Thoracic Surgery, San Yat-sen University Cancer Center, Guangzhou 510060, China
| | - Chun Chen
- Department of Thoracic Surgery, Fujian Medical University Union Hospital, Fujian 350001, China
| | - Haiquan Chen
- Department of Thoracic Surgery, Cancer Hospital, Fudan University, Shanghai 200032, China
| | - Keneng Chen
- Department of Thoracic Surgery, Beijing University Cancer Center, Beijing 100142, China
| | - Ming Du
- Department of Thoracic Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
| | - Yongtao Han
- Department of Thoracic Surgery, Sichuan Cancer Hospital and Institute, Chengdu 610041, China
| | - Jian Hu
- Department of Thoracic Surgery, First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310003, China
| | - Jianhua Fu
- Department of Thoracic Surgery, San Yat-sen University Cancer Center, Guangzhou 510060, China
| | - Xiaobin Hou
- Department of Thoracic Surgery, Chinese PLA General Hospital, Beijing 100853, China
| | - Taiqian Gong
- Department of Thoracic Surgery, Navy General Hospital of PLA, Beijing 100037, China
| | - Yin Li
- Department of Thoracic Surgery, Henan Cancer Hospital, Zhengzhou 450008, China
| | - Junfeng Liu
- Department of Thoracic Surgery, The Fourth Affiliated Hospital of Hebei Medical University, Shijiazhuang 050011, China
| | - Shuoyan Liu
- Department of Thoracic Surgery, Fujian Provincial Tumor Hospital, Fuzhou 350014, China
| | - Lijie Tan
- Department of Thoracic Surgery, Shanghai Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Hui Tian
- Department of Thoracic Surgery, Qilu Hospital of Shandong University, Jinan 250012, China
| | - Qun Wang
- Department of Thoracic Surgery, Shanghai Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Jiaqing Xiang
- Department of Thoracic Surgery, Cancer Hospital, Fudan University, Shanghai 200032, China
| | - Meiqing Xu
- Department of Thoracic Surgery, The First Affiliated Hospital of University of Science and Technology of China (Anhui Provincial Hospital), Hefei 230001, China
| | | | | | - Renquan Zhang
- Department of Thoracic Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei 230022, China
| | - Yan Zhao
- Department of Thoracic Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing 100020, China
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Identification of risk factors and the pattern of lower cervical lymph node metastasis in esophageal cancer: implications for radiotherapy target delineation. Oncotarget 2018; 8:43389-43396. [PMID: 28118614 PMCID: PMC5522154 DOI: 10.18632/oncotarget.14761] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2016] [Accepted: 01/10/2017] [Indexed: 12/25/2022] Open
Abstract
Radiotherapy remains the important therapeutic strategy for patients with esophageal cancer (EC). At present, there is no uniform opinion or standard care on the range of radiotherapy in the treatment of EC patients. This study aimed to investigate the risk factors associated with lower cervical lymph node metastasis (LNM) and to explore the distribution pattern of lower cervical metastatic lymph nodes. It could provide useful information regarding accurate target volume delineation for EC. We identified 239 patients who initial diagnosed with esophageal squamous cell carcinoma. The clinicopathological factors related to LNM were analyzed and the locations of the lower cervical metastatic lymph nodes were transferred onto computed tomography images. The lower cervical area was further divided into four subgroups areas. The results showed that the incidence of lower cervical LNM was 37.2 % (89 of 239) and 94.4 % (84 of 89 patients) patients had subgroup II and/or subgroup III region LNM. Of those patients, 151 nodes were considered to be clinical metastatic in the lower cervical region and 96% nodes were located in group II and group III. Based on the present study, prophylactic irradiating to lower cervical areas is recommended for patients with deeper tumor invasion, the mediastinal level 1, 2, and 4 station LNM and the more number of LNM. The atlas showed that, for the lower cervical area, the subgroup II and III region should be precisely covered in the target volume and the subgroup I and IV may be spared for minimizing the toxicity.
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刘 江, 朱 君, 张 亚, 白 杨. [Expression pattern of FAM135B and K (lysine) acetyltransferase 5 in esophageal squamous cell carcinoma in Uygur patients]. NAN FANG YI KE DA XUE XUE BAO = JOURNAL OF SOUTHERN MEDICAL UNIVERSITY 2018; 38:224-228. [PMID: 29502064 PMCID: PMC6743880 DOI: 10.3969/j.issn.1673-4254.2018.02.17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 01/15/2017] [Indexed: 06/08/2023]
Abstract
OBJECTIVE To explore the expression of the family with sequence similarity 135 member B (FAM135B) and K(lysine) acetyltransferase 5 (KAT5) in esophageal squamous cell carcinoma (ESCC) in Uygur patients. METHODS The expression of FAM135B and KAT5 in ESCC tissues and paired adjacent tissues from 40 Uygur patients were detected using Roche Benchmark XT. The correlation of FAM135B and KAT5 and their correlation with the clinicopathological characteristics of the patients were analyzed. RESULTS The positivity rates of FAM135B and KAT5 in ESCC tissues were 92.50% (37/40) and 15.00%(6/40) in these patients, respectively. The ESCC tissues showed a significantly higher rate of strong FAM135B expression than the adjacent tissues [45.00% (18/40) vs 22.50% (9/40); Χ2=4.528, P=0.033], but the rates of negative KAT5 expression was similar between ESCC and adjacent tissues [85.00% (34/40) vs 87.50% (35/40); Χ2=0.105, P=0.745]. Strong expressions of FAM135B in ESCC tissues and the paired adjacent tissues were well correlated (Kendall's coefficient = 0.707, P<0.001). In ESCC tissues, a strong expression of FAM135B showed a significant negative correlation with KAT5 expression (Kendall's coefficient=-0.946, P<0.001). Neither FAM135B nor KAT5 expression was associated with the patients' gender, age, tumor site, tumor differentiation, invasion, lymph node metastasis and clinical stage (all P>0.05). CONCLUSION A strong expression of FAM135B may be an important molecular basis for the occurrence of ESCC in Uygur patients and plays its role by negatively regulating the expression of KAT5.
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Affiliation(s)
- 江 刘
- 南方医科大学南方医院 消化内科,广东 广州 510515Department of Gastroenterology, Nanfang hospital, Southern Medical University, Guangzhou 510515, China
| | - 君玲 朱
- 新疆喀什地区第一人民医院病理科,新疆 喀什 844000Dpartment of Pathology, Kashi First People's Hospital, Kashi 84400, China
| | - 亚历 张
- 南方医科大学南方医院 消化内科,广东 广州 510515Department of Gastroenterology, Nanfang hospital, Southern Medical University, Guangzhou 510515, China
| | - 杨 白
- 南方医科大学南方医院 消化内科,广东 广州 510515Department of Gastroenterology, Nanfang hospital, Southern Medical University, Guangzhou 510515, China
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Lin Z, Chen W, Chen Y, Peng X, Zhu K, Lin Y, Lin Q, Hu Z. A new classification of lymph node metastases according to the lymph node stations for predicting prognosis in surgical patients with esophageal squamous cell carcinoma. Oncotarget 2018; 7:76261-76273. [PMID: 27788489 PMCID: PMC5342812 DOI: 10.18632/oncotarget.12842] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2016] [Accepted: 10/12/2016] [Indexed: 01/02/2023] Open
Abstract
Lymph node metastasis (LNM) is one of the major prognostic factors for esophageal squamous cell carcinoma (ESCC). However there is no consensus regarding the prognostic significance of the location of LNM. Therefore, a novel classification was proposed to identify the lymph node (LN) stations which may be useful in predicting prognosis. A total of 260 ESCC patients were enrolled in this prospective study. The prognostic values of LNM in different lymph node (LN) stations were evaluated by random survival forests (RSF). Their prognostic significance was examined by Cox regression and receiver operating characteristic curve (ROC). The three most frequently involved LN stations were station 16 (24.49%), station 1 (22.22%) and station 2 (21.05%). Stations 1, 2, 8M, 8L and 16 were grouped as dominant LN stations (DLNS) which showed higher values in predicting overall survival (OS) and disease-free survival (DFS) than the remaining LN stations, which we define as non-dominant LN stations (N-DLNS). LNM features of DLNS (number of positive LN stations, number of positive LNs and LN ratio), but not those from N-DLNS, served as independent prognostic factors (P<0.05) whenever used alone or when combined with factors from N-DLNS. Furthermore, the area under ROC indicated that DLNS is a more accurate prediction than N-DLNS (P<0.05). This study demonstrated the value of LNM in DLNS in predicting prognosis in surgical ESCC patients, which outperformed those from N-DLNS. Therefore, the method of dominant and non-dominant classification may serve as an additional parameter to improve individualized therapeutic strategies.
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Affiliation(s)
- Zheng Lin
- Department of Epidemiology and Health Statistics, Fujian Provincial Key Laboratory of Environment Factors and Cancer, School of Public Health, Fujian Medical University, Fuzhou 350108, China
| | - Weilin Chen
- Department of Radiation Oncology, Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou 363000, China
| | - Yuanmei Chen
- Department of Thoracic Surgery, Fujian Provincial Cancer Hospital Affiliated to Fujian Medical University, Fuzhou 350014, China
| | - Xiane Peng
- Department of Epidemiology and Health Statistics, Fujian Provincial Key Laboratory of Environment Factors and Cancer, School of Public Health, Fujian Medical University, Fuzhou 350108, China.,Key Laboratory of Ministry of Education for Gastrointestinal Cancer, Fujian Medical University, Minhou, Fuzhou 350108, China
| | - Kunshou Zhu
- Department of Thoracic Surgery, Fujian Provincial Cancer Hospital Affiliated to Fujian Medical University, Fuzhou 350014, China
| | - Yimin Lin
- Department of Epidemiology and Health Statistics, Fujian Provincial Key Laboratory of Environment Factors and Cancer, School of Public Health, Fujian Medical University, Fuzhou 350108, China
| | - Qiaokuang Lin
- Department of Radiation Oncology, Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou 363000, China
| | - Zhijian Hu
- Department of Epidemiology and Health Statistics, Fujian Provincial Key Laboratory of Environment Factors and Cancer, School of Public Health, Fujian Medical University, Fuzhou 350108, China.,Key Laboratory of Ministry of Education for Gastrointestinal Cancer, Fujian Medical University, Minhou, Fuzhou 350108, China
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Wang WP, He SL, Yang YS, Chen LQ. Strategies of nodal staging of the TNM system for esophageal cancer. ANNALS OF TRANSLATIONAL MEDICINE 2018; 6:77. [PMID: 29666800 DOI: 10.21037/atm.2017.12.17] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
The 8th edition of UICC/AJCC TNM staging for esophageal cancer will start in use since 2018. The nodal staging in this version of TNM system remains unchanged from the 7th edition that based on the number of lymph nodes (LN) involved, except the limited revision of the regional LN map. In this review, N staging revision was evaluated from its initially simple definition of negative (N0) and positive (N1) LN(s) to the current positive node number based proposal. Meanwhile the disadvantages of current N staging were discussed. The refined nodal staging system in view of the number of metastatic node stations was introduced; as well as the extent and station of metastatic node could better reflect the disease progression and prognosis. The controversy on N staging of esophagogastric junction cancer was also discussed. Other reported N staging associated elements including LN ratio and lymphatic vessel invasion were reviewed and evaluated.
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Affiliation(s)
- Wen-Ping Wang
- Department of Thoracic Surgery, West China Hospital of Sichuan University, Chengdu 610041, China
| | - Song-Lin He
- Department of Thoracic Surgery, West China Hospital of Sichuan University, Chengdu 610041, China
| | - Yu-Shang Yang
- Department of Thoracic Surgery, West China Hospital of Sichuan University, Chengdu 610041, China
| | - Long-Qi Chen
- Department of Thoracic Surgery, West China Hospital of Sichuan University, Chengdu 610041, China
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30
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Lin D, Jiang S, Ma L, Hu H, Ye T, Shao L, Song Z, Xiang J. Clinical analyses on salvage lymphadenectomy through cervical incision for patients with cervical and cervicothoracic recurrences after esophagectomy. J Thorac Dis 2017; 9:3832-3839. [PMID: 29268392 DOI: 10.21037/jtd.2017.09.124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background Locoregional recurrences are often observed after esophagectomy with lymphadenectomy. The treatment strategy for these patients has not been established completely. The purpose of this study was to evaluate the prognosis of salvage lymphadenectomy through the cervical incision for cervical and cervicothoracic recurrences. Methods We retrospectively reviewed patients underwent initial esophagectomy and then salvage lymphadenectomy in Fudan University Shanghai Cancer Center during July 2006 and September 2016. Survival curve was calculated by Kaplan-Meier method. Prognostic factors for post-salvage lymphadenectomy overall survival (PSL-OS) were identified by univariate and multivariate analyses. Results The median disease-free survival (DFS) was 8 months. The median PSL-OS was 40 months (95% CI: 8.850-71.150). The 1-, 2-, 3- and 5-year PSL-OS rate were 87%, 58%, 52% and 41%, respectively. Univariate and multivariate analyses confirmed the initial TNM stage was the only independent prognostic factor for PSL-OS (P=0.000 by log-rank test, P=0.009 by Cox hazards model, HR 3.999, 95% CI: 1.413-11.316) among these patients. Conclusions PSL survival could be considerable for patients with early initial tumor stage. Prospective studies are warranted to clarify the value of salvage lymphadenectomy.
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Affiliation(s)
- Dong Lin
- Department of Thoracic Surgery, Fudan University Shanghai Cancer Center, Shanghai 200032, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China
| | - Shujun Jiang
- Department of Thoracic Surgery, Fudan University Shanghai Cancer Center, Shanghai 200032, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China
| | - Longfei Ma
- Department of Thoracic Surgery, Fudan University Shanghai Cancer Center, Shanghai 200032, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China
| | - Hong Hu
- Department of Thoracic Surgery, Fudan University Shanghai Cancer Center, Shanghai 200032, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China
| | - Ting Ye
- Department of Thoracic Surgery, Fudan University Shanghai Cancer Center, Shanghai 200032, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China
| | - Longlong Shao
- Department of Thoracic Surgery, Fudan University Shanghai Cancer Center, Shanghai 200032, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China
| | - Zuodong Song
- Department of Thoracic Surgery, Fudan University Shanghai Cancer Center, Shanghai 200032, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China
| | - Jiaqing Xiang
- Department of Thoracic Surgery, Fudan University Shanghai Cancer Center, Shanghai 200032, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China
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Numeric pathologic lymph node classification shows prognostic superiority to topographic pN classification in esophageal squamous cell carcinoma. Surgery 2017; 162:846-856. [PMID: 28739092 DOI: 10.1016/j.surg.2017.06.013] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2017] [Revised: 06/19/2017] [Accepted: 06/19/2017] [Indexed: 01/20/2023]
Abstract
BACKGROUND The current eighth tumor node metastasis lymph node category pathologic lymph node staging system for esophageal squamous cell carcinoma is based solely on the number of metastatic nodes and does not consider anatomic distribution. We aimed to assess the prognostic capability of the eighth tumor node metastasis pathologic lymph node staging system (numeric-based) compared with the 11th Japan Esophageal Society (topography-based) pathologic lymph node staging system in patients with esophageal squamous cell carcinoma. METHODS We retrospectively reviewed the clinical records of 289 patients with esophageal squamous cell carcinoma who underwent esophagectomy with extended lymph node dissection during the period from January 2006 through June 2016. We compared discrimination abilities for overall survival, recurrence-free survival, and cancer-specific survival between these 2 staging systems using C-statistics. RESULTS The median number of dissected and metastatic nodes was 61 (25% to 75% quartile range, 45 to 79) and 1 (25% to 75% quartile range, 0 to 3), respectively. The eighth tumor node metastasis pathologic lymph node staging system had a greater ability to accurately determine overall survival (C-statistics: tumor node metastasis classification, 0.69, 95% confidence interval, 0.62-0.76; Japan Esophageal Society classification; 0.65, 95% confidence interval, 0.58-0.71; P = .014) and cancer-specific survival (C-statistics: tumor node metastasis classification, 0.78, 95% confidence interval, 0.70-0.87; Japan Esophageal Society classification; 0.72, 95% confidence interval, 0.64-0.80; P = .018). Rates of total recurrence rose as the eighth tumor node metastasis pathologic lymph node stage increased, while stratification of patients according to the topography-based node classification system was not feasible. CONCLUSION Numeric nodal staging is an essential tool for stratifying the oncologic outcomes of patients with esophageal squamous cell carcinoma even in the cohort in which adequate numbers of lymph nodes were harvested.
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Lv WQ, Wei WZ, Wu WB, Zeng GQ, Huang RX, Zhang LS. Significance of Upper Mediastinal Lymph Node Dissection with Video-Assisted Thoracic Surgery in the Treatment of Middle Thoracic Esophageal Carcinoma. J Laparoendosc Adv Surg Tech A 2017; 27:1061-1064. [PMID: 28574749 DOI: 10.1089/lap.2016.0625] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND The aim of this study was to explore the significance of upper mediastinal lymph node dissection performed by video-assisted thoracic surgery in the treatment of middle thoracic esophageal carcinoma. MATERIALS AND METHODS The clinical and pathological data from 128 patients with middle thoracic esophageal carcinoma who underwent surgery from January 2013 to December 2015 using a right chest-abdomen-neck approach combined with thoracoscopy and laparoscopy in the Jieyang People's Hospital of Huangdong province were analyzed retrospectively. RESULTS The lymph node metastasis rates of the thoracic left para-recurrent laryngeal nerve (1, 2, and 4L zones) and right para-recurrent laryngeal nerve (1R zone) were 30.47% and 28.12% in 128 cases, respectively. The metastasis rates of the 2R, 4R, and 5 zones were 4.69%, 3.91%, and 5.47%, respectively. CONCLUSIONS The upper mediastinal region was the most common location for lymph node metastasis from middle thoracic esophageal carcinoma, and upper mediastinal lymph node dissection performed by video-assisted thoracic surgery was safe and complete. It also reduced the risk of para-recurrent laryngeal nerve injury, residual tumor, and the postoperative recurrence rate.
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Affiliation(s)
- Wen-Qiang Lv
- 1 Department of Thoracic and Cardiovascular Surgery, People's Hospital of Jieyang , Jieyang, China
| | - Wu-Zhi Wei
- 1 Department of Thoracic and Cardiovascular Surgery, People's Hospital of Jieyang , Jieyang, China
| | - Wei-Bin Wu
- 1 Department of Thoracic and Cardiovascular Surgery, People's Hospital of Jieyang , Jieyang, China
| | - Gui-Qing Zeng
- 1 Department of Thoracic and Cardiovascular Surgery, People's Hospital of Jieyang , Jieyang, China
| | - Rui-Xin Huang
- 2 Department of Anesthesiology, People's Hospital of Jieyang , Jieyang, China
| | - Long-Sheng Zhang
- 2 Department of Anesthesiology, People's Hospital of Jieyang , Jieyang, China
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Li B, Xiang J, Zhang Y, Hu H, Sun Y, Chen H. Factors Affecting Hospital Mortality in Patients with Esophagogastric Anastomotic Leak: A Retrospective Study. World J Surg 2016; 40:1152-7. [PMID: 26678489 DOI: 10.1007/s00268-015-3372-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE We aimed to clarify the association between anastomotic leak and leak-associated mortality to assist decision-making and reduce hospital mortality. BACKGROUND Anastomotic leak is a common complication after esophagectomy, but the nature of its relationship to leak-associated mortality has not been established. METHODS A retrospective review of all esophagogastric anastomotic leaks that had occurred between 2008 and 2012 at our institution (n = 246) was performed. Risk factors for leak-associated mortality were determined using a multivariate logistic regression analysis. RESULTS Of the 246 patients with anastomotic leaks, 14 (5.7 %) died. Leak-associated mortality rates were similar regardless of anastomosis location (cervical vs. thoracic anastomosis), surgical approaches (retrosternal vs. prevertebral reconstruction route) and anastomotic techniques (hand-sewn vs. mechanical anastomosis). When a leak occurred, risk factors for leak-associated mortality as determined by multivariate logistic analysis included patient age >60 years (P = 0.029) and the occurrence of the leak within 1 week of surgery (P = 0.039). When disease worsened after treatment, leak-associated mortality was more frequent in patients requiring reintubation (25.6 vs. 1.4 %, P < 0.001). Fatal bleeding and sepsis were the most common causes of leak-associated mortality. CONCLUSION In patients with anastomotic leaks, patient age >60 years and the occurrence of the leak within 1 week of surgery were risk factors for leak-associated mortality. Increased efforts to reduce the incidence of early anastomotic leaks within 1 week after surgery and prevent the need for reintubation are important for improving patient prognosis.
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Affiliation(s)
- Bin Li
- Department of Thoracic Surgery, Fudan University Shanghai Cancer Center, Shanghai, China
- Department of Oncology, Shanghai Medical College, Fudan University, 270#Dong'an Rd, Shanghai, 20032, China
| | - Jiaqing Xiang
- Department of Thoracic Surgery, Fudan University Shanghai Cancer Center, Shanghai, China
- Department of Oncology, Shanghai Medical College, Fudan University, 270#Dong'an Rd, Shanghai, 20032, China
| | - Yawei Zhang
- Department of Thoracic Surgery, Fudan University Shanghai Cancer Center, Shanghai, China
- Department of Oncology, Shanghai Medical College, Fudan University, 270#Dong'an Rd, Shanghai, 20032, China
| | - Hong Hu
- Department of Thoracic Surgery, Fudan University Shanghai Cancer Center, Shanghai, China
- Department of Oncology, Shanghai Medical College, Fudan University, 270#Dong'an Rd, Shanghai, 20032, China
| | - Yihua Sun
- Department of Thoracic Surgery, Fudan University Shanghai Cancer Center, Shanghai, China
- Department of Oncology, Shanghai Medical College, Fudan University, 270#Dong'an Rd, Shanghai, 20032, China
| | - Haiquan Chen
- Department of Thoracic Surgery, Fudan University Shanghai Cancer Center, Shanghai, China.
- Department of Oncology, Shanghai Medical College, Fudan University, 270#Dong'an Rd, Shanghai, 20032, China.
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Jiang W, Wang Z, Jia Y. CEP55 overexpression predicts poor prognosis in patients with locally advanced esophageal squamous cell carcinoma. Oncol Lett 2016; 13:236-242. [PMID: 28123547 PMCID: PMC5244839 DOI: 10.3892/ol.2016.5414] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2015] [Accepted: 10/27/2016] [Indexed: 12/29/2022] Open
Abstract
Development of esophageal squamous cell carcinoma (ESCC) involves alterations in multiple genes with corresponding proteins. Recent studies have demonstrated that centrosomal protein 55 (CEP55) shares certain features with oncogenes, and CEP55 overexpression is associated with the development and progression of malignant tumors. The present study aimed to analyze, for the first time, whether CEP55 expression is related to clinicopothalogic features in the esophageal squamous cell carcinoma (ESCC), as well as patient survival. A total of 110 patients with mid-thoracic ESCC who suffered from Ivor-Lewis were enrolled. The CEP55 expression profile of these patients in tumour tissues and corresponding healthy esophageal mucosa (CHEM) was detected by immunohistochemistry and semi-quantitative reverse transcription-polymerase chain reaction analyses. Correlations between CEP55 expression and clinicopathological factors were analyzed using χ2 test. The log-rank test was employed to calculate survival rate. A Cox regression multivariate analysis was performed to determine independent prognostic factors. The results demonstrated that CEP55 expression in ESCC was significantly higher than that of CHEM (P<0.001). Overexpression of CEP55 was significantly associated with differentiation degree (P=0.022), T stage (P=0.019), lymph node metastasis (P=0.033), clinicopathological staging (P=0.002) and tumor recurrence (P=0.021) in locally advanced ESCC patients. In addition, CEP55 overexpression was significantly associated with reduced overall survival of patients after surgery (P=0.012). The 5-year survival rate of patients without CEP55 overexpression was significantly higher than that of patients with CEP55 overexpression (P=0.012). Therefore, these findings suggest that CEP55 overexpression correlates with poor prognosis in locally advanced ESCC patients.
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Affiliation(s)
- Wenpeng Jiang
- Department of Thoracic Surgery, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, Shandong 250021, P.R. China
| | - Zhou Wang
- Department of Thoracic Surgery, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, Shandong 250021, P.R. China
| | - Yang Jia
- Department of Thoracic Surgery, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, Shandong 250021, P.R. China
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Yu S, Lin J, Chen C, Lin J, Han Z, Lin W, Kang M. Recurrent laryngeal nerve lymph node dissection may not be suitable for all early stage esophageal squamous cell carcinoma patients: an 8-year experience. J Thorac Dis 2016; 8:2803-2812. [PMID: 27867556 DOI: 10.21037/jtd.2016.10.34] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
BACKGROUND Recurrent laryngeal nerve (RLN) injury is one of the most frequent postoperative complications of esophageal squamous cell carcinoma (ESCC) radical resection. This study aims to develop a novel scoring system to predict recurrent laryngeal nerve lymph node (RLNLN) metastases in early ESCC and explore the indications for precise RLN lymphadenectomy. METHODS Early stage ESCC patients from 2006 to 2014 were analyzed. Patient and pathologic characteristics were compared between patients with RLNLN metastases and those without. Univariate and multivariate analyses were performed to establish a scoring system that estimates the risks of RLNLN metastases. The indications for RLNLN dissection were validated by survival rate, postoperative complications, and metastases rate. RESULTS A total of 311 cases selected from 1,466 ESCC patients were divided into the dissection group and the control group. Age, tumor length, macroscopic tumor type, T stage, tumor location and tumor differentiation were independent predictors of RLNLN metastases. The weighted scoring system included age (+2 for <56 years), tumor length (+2 for over 4.45 cm), tumor location (+4 for upper thoracic, +2 for mid-thoracic) and macroscopic tumor type (+1 for advanced type). The total number of points estimated the probability of RLNLN metastases [low-risk (0-2 point), 0%; moderate-risk (3-4 points), 9.8%; and high-risk (>4 points), 43.4%]. Besides, the dissection group had more complications and similar survival rate when compared with the control group. CONCLUSIONS We developed a novel scoring system that accurately estimated the risk of RLNLN metastases in early ESCC patients. RLN lymphadenectomy may be safely omitted for the patients in the low-risk subgroup.
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Affiliation(s)
- Shaobin Yu
- The Second Department of Thoracic Surgery, Fujian Medical University Union Hospital, Fuzhou 350001, China
| | - Jihong Lin
- The Second Department of Thoracic Surgery, Fujian Medical University Union Hospital, Fuzhou 350001, China
| | - Chenshu Chen
- The Second Department of Thoracic Surgery, Fujian Medical University Union Hospital, Fuzhou 350001, China
| | - Jiangbo Lin
- The Second Department of Thoracic Surgery, Fujian Medical University Union Hospital, Fuzhou 350001, China
| | - Ziyang Han
- The Second Department of Thoracic Surgery, Fujian Medical University Union Hospital, Fuzhou 350001, China
| | - Wenwei Lin
- The Second Department of Thoracic Surgery, Fujian Medical University Union Hospital, Fuzhou 350001, China
| | - Mingqiang Kang
- The Second Department of Thoracic Surgery, Fujian Medical University Union Hospital, Fuzhou 350001, China
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Peng J, Wang WP, Yuan Y, Wang ZQ, Wang Y, Chen LQ. Adequate lymphadenectomy in patients with oesophageal squamous cell carcinoma: resecting the minimal number of lymph node stations. Eur J Cardiothorac Surg 2016; 49:e141-6. [PMID: 26905182 DOI: 10.1093/ejcts/ezw015] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2015] [Accepted: 01/11/2016] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVES The seventh edition of the American Joint Committee on Cancer (AJCC) tumour-node-metastasis (TNM) staging system for oesophageal cancer did not define the minimal requirement for an adequate extent of lymphadenectomy in patients with oesophageal cancer. This study aimed to define the minimum number of lymph node (LN) stations to be resected in patients with oesophageal squamous cell carcinoma (OSCC). METHODS We conducted a retrospective review of clinicopathological data from 2033 patients with OSCC undergoing complete resection between August 2005 and September 2013. An ordinal logistic regression analysis was used to identify the variables associated with revised N (rN) staging progression and indices that could be used in the stratified analysis. To determine the optimal number of resected LN stations, we compared the overall survival hazard ratio between groups with different numbers of LN stations using a Cox's proportional hazards regression model. The highest χ(2) value was deemed the cut-off point. RESULTS The progression of rN staging was influenced by T-staging, G-staging, tumour length (>3 cm), lymphovascular invasion and number of resected LN stations. According to Cox's proportional hazards regression model, we recommended that at least six LN stations should be removed. Then, we conducted a stratified analysis by G status and tumour length. We found that at least seven LN stations should be removed in patients with G3 or tumour length >3 cm. CONCLUSIONS For thoracic OSCC, at least six LN stations had to be removed. Furthermore, for patients with G3 or tumour length >3 cm, the recommendation was seven.
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Affiliation(s)
- Jun Peng
- Department of Thoracic Surgery, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Wen-Ping Wang
- Department of Thoracic Surgery, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Yong Yuan
- Department of Thoracic Surgery, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Zhi-Qiang Wang
- Department of Thoracic Surgery, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Yun Wang
- Department of Thoracic Surgery, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Long-Qi Chen
- Department of Thoracic Surgery, West China Hospital of Sichuan University, Chengdu, Sichuan, China
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37
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Peng J, Wang WP, Dong T, Cai J, Ni PZ, Chen LQ. Refining the Nodal Staging for Esophageal Squamous Cell Carcinoma Based on Lymph Node Stations. Ann Thorac Surg 2016; 101:280-6. [DOI: 10.1016/j.athoracsur.2015.06.081] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2015] [Revised: 06/15/2015] [Accepted: 06/22/2015] [Indexed: 12/15/2022]
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38
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Van De Voorde L, Larue RT, Pijls M, Buijsen J, Troost EG, Berbée M, Sosef M, van Elmpt W, Schraepen MC, Vanneste B, Oellers M, Lambin P. A qualitative synthesis of the evidence behind elective lymph node irradiation in oesophageal cancer. Radiother Oncol 2014; 113:166-74. [DOI: 10.1016/j.radonc.2014.11.010] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2014] [Revised: 10/10/2014] [Accepted: 11/09/2014] [Indexed: 12/21/2022]
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39
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Feng JF, Zhao Q, Chen QX. Prognostic value of subcarinal lymph node metastasis in patients with esophageal squamous cell carcinoma. Asian Pac J Cancer Prev 2014; 14:3183-6. [PMID: 23803101 DOI: 10.7314/apjcp.2013.14.5.3183] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
PURPOSE The 7th edition of the American Joint Committee on Cancer Staging Manual for esophageal cancer (EC) categorizes N stage according to the number of metastatic lymph nodes (LNs), irrespective of the site. The aim of this study was to determine the prognostic value of subcarinal LN metastasis in patients undergoing esophagectomy for esophageal squamous cell carcinoma (ESCC). METHODS A retrospective analysis of 507 consecutive patients with ESCC was conducted. Potential clinicopathological factors that could influence subcarinal LN metastasis were statistically analyzed. Univariate and multivariate analyses were also performed to evaluate the prognostic parameters for survival. RESULTS The frequency of subcarinal LN metastasis was 22.9% (116/507). Logistic regression analysis showed that tumor length (>3 cm vs ≤ 3 cm; P=0.027), tumor location (lower vs upper/middle; P=0.009), vessel involvement (Yes vs No; P=0.001) and depth of invasion (T3-4a vs T1-2; P=0.012) were associated with 2.085-, 1.810-, 2.535- and 2.201- fold increases, respectively, for risk of subcarinal LN metastasis. Multivariate analyses showed that differentiation (poor vs well/moderate; P=0.001), subcarinal LN metastasis (yes vs no; P=0.033), depth of invasion (T3-4a vs T1-2; P=0.014) and N staging (N1-3 vs N0; P=0.001) were independent prognostic factors. In addition, patients with subcarinal LN metastasis had a significantly lower 5-year cumulative survival rate than those without (26.7% vs 60.9%; P<0.001). CONCLUSIONS Subcarinal LN metastasis is a predictive factor for long-term survival in patients with ESCC.
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Affiliation(s)
- Ji-Feng Feng
- Department of Thoracic Surgery, Zhejiang Cancer Hospital, Hangzhou, Zhejiang Province, China.
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Ye T, Chen H. Reply: To PMID 24055234. Ann Thorac Surg 2014; 98:390. [PMID: 24996741 DOI: 10.1016/j.athoracsur.2014.04.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2014] [Revised: 03/19/2014] [Accepted: 04/01/2014] [Indexed: 11/16/2022]
Affiliation(s)
- Ting Ye
- Department of Thoracic Surgery, Fudan University Cancer Hospital (Shanghai Cancer Hospital), 270 Dong'an Rd, Shanghai P.R.China, Shanghai, China 200032
| | - Haiquan Chen
- Department of Thoracic Surgery, Fudan University Cancer Hospital (Shanghai Cancer Hospital), 270 Dong'an Rd, Shanghai P.R.China, Shanghai, China 200032.
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Hsu PK, Huang CS, Hsieh CC, Wu YC, Hsu WH. Role of right upper mediastinal lymph node metastasis in patients with esophageal squamous cell carcinoma after tri-incisional esophagectomies. Surgery 2014; 156:1269-77. [PMID: 24953277 DOI: 10.1016/j.surg.2014.05.007] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2013] [Accepted: 05/12/2014] [Indexed: 10/25/2022]
Abstract
BACKGROUND Whereas standard (infracarinal) mediastinal lymphadenectomy refers to the clearance of lymph nodes in the middle and lower posterior mediastinum, extension along right side of trachea and upper mediastinum is termed extended lymphadenectomy. The benefit of an extended versus standard lymphadenectomy in esophageal cancer is unclear. METHODS The clinicopathologic data of 391 patients undergoing tri-incisional esophagectomy (McKeown type) for squamous cell carcinoma between 1995 and 2007 were analyzed retrospectively. There were 136 and 255 patients in the infracarinal and extended mediastinal lymphadenectomy groups, respectively. The outcome of these two groups and the clinical importance of right upper mediastinum lymph node metastases (LNM) were investigated. RESULTS Both groups were comparable in clinicopathologic characteristics except tumor length (infracarinal vs extended group, 4.6 vs 5.2 cm, P = .023) and lymph node status. The 5-year overall survival rates were 29.7% and 27.3%, in the infracarinal and extended groups, respectively (P = .065). In the extended group, the factors correlated to right upper mediastinal LNM included neck LNM (hazard ratio [HR] 2.621, P = .029), abdominal LNM (HR 2.218, P = .016), and tumor locating in the upper/middle third of esophagus (HR 2.781, P = .014). The independent prognostic factors for overall survival included right upper mediastinal LNM (HR 1.964, P < .001), lower mediastinal LNM (HR 1.391, P = .039), and abdominal LNM (HR 1.538, P = .006). CONCLUSION The procedure of right upper mediastinum lymphadenectomy is not associated with better survival in patients with esophageal squamous cell carcinoma patients; the presence of upper mediastinum LNM predicted poor prognosis.
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Affiliation(s)
- Po-Kuei Hsu
- Division of Thoracic Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan; School of Medicine, National Yang-Ming University, Taipei, Taiwan; Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan.
| | - Chien-Sheng Huang
- Division of Thoracic Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan; School of Medicine, National Yang-Ming University, Taipei, Taiwan; Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Chih-Cheng Hsieh
- Division of Thoracic Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan; School of Medicine, National Yang-Ming University, Taipei, Taiwan; Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Yu-Chung Wu
- Division of Thoracic Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan; School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Wen-Hu Hsu
- Division of Thoracic Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan; School of Medicine, National Yang-Ming University, Taipei, Taiwan
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Akhtar J, Wang Z, Jiang WP, Bi MM, Zhang ZP. Stathmin overexpression identifies high risk for lymphatic metastatic recurrence in pN0 esophageal squamous cell carcinoma patients. J Gastroenterol Hepatol 2014; 29:944-50. [PMID: 24372619 DOI: 10.1111/jgh.12498] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/12/2013] [Indexed: 12/18/2022]
Abstract
BACKGROUND AND AIM Common patterns of the operative failure after Ivor-Lewis esophagectomy in esophageal squamous cell carcinoma (ESCC) patients are locoregional lymph node metastasis. It is clinically significant to investigate the biological markers to predict the subset of patients who are at higher risk of lymphatic metastatic recurrence. Our research aimed to investigate the association between the Stathmin (STMN-1) gene expression and lymphatic metastatic recurrence in pN0 ESCC patients after surgery. METHODS One hundred seventy-four patients who suffered from mid-thoracic ESCC and completely resected with Ivor-Lewis esophagectomy were enrolled in our study. The entire patients were restricted to pN0 ESCC. Tissue specimens were examined for STMN-1 expression levels by immunohistochemistry and Western blotting methods. The correlation of STMN-1 levels with clinicopathological variables, prognosis, and metastatic potential was analyzed. RESULTS One hundred patients had STMN-1 protein overexpression (57.47%), and the patients with overexpression were accompanied by significantly higher rate of lymphatic metastatic recurrence as compared with patients who had low STMN-1 expression (P = 0.003). Multivariable Cox regression analysis revealed that the STMN-1 protein expression and T classification were independent factors to predict the lymphatic metastatic recurrence (P = 0.007, P = 0.000, respectively). CONCLUSIONS Even pN0 ESCC are a potential to lymphatic metastatic recurrence. Stathmin overexpression can be used as a marker to identify those patients who are at high risk for lymphatic metastatic recurrence in pN0 ESCC after an Ivor-Lewis esophagectomy.
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Affiliation(s)
- Javed Akhtar
- Department of Thoracic Surgery, Provincial Hospital Affiliated to Shandong University, Jinan, Shandong, China
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Takeno S, Takahashi Y, Hashimoto T, Maki K, Shibata R, Yamana I, Sasaki T, Yoshida Y, Shiwaku H, Yamashita K, Aisu N, Yamashita Y, Moroga T, Ono K, Kawahara K. Is the prognostic impact of tumor location in patients with surgically resected esophageal squamous cell carcinoma affected by surgical approach? ACTA ACUST UNITED AC 2013; 51:91-8. [PMID: 24157453 DOI: 10.1159/000355680] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2013] [Accepted: 09/17/2013] [Indexed: 11/19/2022]
Abstract
AIM The aim of the present study was to clarify differences in node metastasis mode and clinical outcomes based on tumor location in patients with esophageal squamous cell carcinoma (ESCC). PATIENTS AND METHODS Participants comprised 228 patients with ESCC who underwent radical esophagectomy without preoperative supplement therapies. Lymph nodes were harvested from three fields: the neck, thorax, and abdomen. Patients were divided into three groups depending on tumor location [upper esophagus (UE), middle esophagus, or lower esophagus (LE)] and analyzed clinicopathologically. RESULTS The LE group showed significantly more progressive ESCC in terms of tumor invasion (p = 0.025), node metastasis (p = 0.0071), and TNM stage (p = 0.0043). The LE group revealed a tendency to metastasize to extrathoracic (especially abdominal) nodes (p = 0.0008). Recurrent laryngeal node metastasis was increased in the UE group (p = 0.016). However, no prognostic differences were detected between groups according to tumor location. Likewise, subgroup analyses by surgical approach (open thoracotomy vs. thoracoscopy) and cancer stage (stage I/II, III, and IV) did not reveal any significant prognostic impact of tumor location. CONCLUSION Lymphatic spread varied by tumor location, but no prognostic impact of tumor location could be detected in patients with ESCC in spite of surgical approach or cancer stage.
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Affiliation(s)
- S Takeno
- Gastroenterological Surgery, Fukuoka University Faculty of Medicine, Fukuoka, Japan
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Kosugi SI, Kawaguchi Y, Kanda T, Ishikawa T, Sakamoto K, Akaike H, Fujii H, Wakai T. Cervical lymph node dissection for clinically submucosal carcinoma of the thoracic esophagus. Ann Surg Oncol 2013; 20:4016-21. [PMID: 23892526 DOI: 10.1245/s10434-013-3141-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2013] [Indexed: 12/15/2022]
Abstract
BACKGROUND The purposes of this study were to clarify the risk factors for supraclavicular lymph node (SCLN) metastasis and the survival benefit from cervical lymph node (LN) dissections in patients with clinically submucosal (cT1b) carcinoma of the thoracic esophagus. METHODS A total of 86 patients with this disease who underwent esophagectomy with 3-field lymph node dissection were retrospectively reviewed. Multivariate logistic regression and Cox proportional hazard model were used to identify the independent risk factors for SCLN metastasis and prognostic factors, respectively. An index calculated by multiplying the frequency of metastasis at nodal basin and the 5-year overall survival rate of patients with metastasis at that basin were used to assess the therapeutic outcomes. RESULTS A total of 40 patients (47%) were found to have pathological LN metastasis. Also, 13 patients (15%) had cervical LN metastasis: 6 and 7 with carcinoma of the upper and mid-thoracic esophagus, respectively. SCLN metastasis was found in 6 patients (7%); however, there was no independent risk factor for SCLN metastasis. The 5-year overall survival rate was 72.5%. Cervical LN metastasis was an independent prognostic factor (p = .04; odds ratio 2.55; 95% confidence interval 1.03-6.31); however, there was no significant difference in survival between patients with SCLN metastasis and those without (p = .06). The calculated index of estimated benefit from cervical LN dissections was 6.9, following upper mediastinal LN of 15.6 and perigastric LN of 8.3. CONCLUSIONS We could not identify risk factors to predict SCLN metastasis. Cervical LN dissection should not be omitted in patients with cT1b carcinoma, especially of the upper and mid-thoracic esophagus.
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Affiliation(s)
- Shin-ichi Kosugi
- Division of Digestive and General Surgery, Niigata University Graduate School of Medical and Dental Sciences, Niigata City, Japan,
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Cavallin F, Scarpa M, Castoro C. More information about the pattern of lymphatic spread could improve the effectiveness of surgery for esophageal cancer. J Thorac Cardiovasc Surg 2013; 145:895-6. [PMID: 23415003 DOI: 10.1016/j.jtcvs.2012.11.089] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2012] [Accepted: 11/09/2012] [Indexed: 10/27/2022]
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Li B, Chen H. Reply to the editor. J Thorac Cardiovasc Surg 2013; 145:896-7. [PMID: 23415005 DOI: 10.1016/j.jtcvs.2012.12.050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2012] [Accepted: 12/11/2012] [Indexed: 11/24/2022]
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Wu N, Chen Z, Pang L, Ma Q, Chen G. Prognostic significance of lymph node characteristics on survival in esophageal squamous cell carcinomas. Wien Klin Wochenschr 2013; 125:26-33. [PMID: 23292643 DOI: 10.1007/s00508-012-0310-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2012] [Accepted: 11/29/2012] [Indexed: 12/14/2022]
Abstract
OBJECTIVES To investigate the prognostic significance of lymph node characteristics (total number of resected lymph nodes, metastatic lymph node ratio, and metastatic lymph nodes site) on survival in patients with esophageal squamous cell carcinoma. METHODS Patients who underwent esophagectomy at Huashan Hospital, Fudan University, between October 1, 2003, and December 31, 2008, were reviewed. Survival data and clinicopathological characteristics were collected. RESULTS Among 205 patients, the median overall survival time was 48.0 months and the overall 5-year survival rate was 44.7 %. The independent risk factors for disease-free survival were the metastatic lymph node ratio (P < 0.001) and the number of positive lymph nodes (P < 0.001) and not the total number of resected lymph nodes (Χ (2) = 3.063, P = 0.216). There was no difference in survival between patients with extrathoracic and intrathoracic lymph node metastasis (Χ (2) = 0.295, P = 0.587). No significant relation was found between tumor location and the site of metastatic lymph nodes (rs = 0.125, P = 0.245). CONCLUSIONS Our finding revealed that the ratio and the number, but not the site, of metastatic lymph nodes were independent prognostic risk factors in esophageal squamous cell carcinomas. We suggest taking these factors into consideration for better estimation of prognosis.
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Affiliation(s)
- Ning Wu
- Department of Cardiothoracic Surgery, Huashan Hospital of Fudan University, 200040 Shanghai, PR China
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