Impact of bulky loco-regional lymphadenopathy in esophageal adenocarcinoma on survival: a retrospective single center analysis.

IF 2.6 3区 医学 Diseases of the Esophagus Pub Date : 2024-10-02 DOI:10.1093/dote/doae046
James Tankel, Yehonathan Nevo, Ruqaiya Al Shehhi, Rawan Sakalla, Mehrnoush Dehghani, Jonathan Spicer, Sara Najmeh, Carmen Mueller, Lorenzo Ferri, Jonathan Cools-Lartigue
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Abstract

The relationship between 'bulky' locoregional lymphadenopathy and survival has not been investigated in the setting of esophageal adenocarcinoma (EAC). This study aimed to explore whether bulky regional lymphadenopathy at diagnosis affected survival outcomes in patients with EAC treated with neoadjuvant chemotherapy and en bloc resection. A single-center retrospective review of a prospectively maintained upper GI cancer surgical database was performed between January 2012 and December 2019. Patients with locally advanced EAC (cT2-3, N+, M0) treated with neoadjuvant docetaxel-based chemotherapy and transthoracic en bloc esophagogastrectomy were identified. Computed tomography scans from before the initiation of treatment were reviewed, and patients were stratified according to whether bulky loco-regional lymph nodes were present. This was defined as lymphadenopathy >2 cm in any axis. Overall survival was compared, and a Cox multivariate regression model was calculated. Two hundred twenty-five of the eight hundred seventy patients identified met the inclusion criteria. Forty-eight (21%) had bulky lymphadenopathy, leaving 177 allocated to the control group. More patients with bulky lymphadenopathy had ypN3 disease (18/48, 38% vs. 39/177, 20%, P = 0.025). Among patients with bulky lymphadenopathy, overall survival was generally worse (32.6 vs. 59.1 months, P = 0.012). However, among the 9/48 (19%) patients with bulky lymphadenopathy who achieved ypN- status survival outcomes were similar to those with non-bulky lymphadenopathy who also achieved lymph node sterilization. Poor differentiation (HR 1.8, 95% CI 1.0-2.9, P = 0.034), ypN+ (HR 1.9, 95% CI 1.1-3.6, P = 0.032), and bulky lymphadenopathy were independently associated with an increased risk of death (HR 1.7, 1.0-2.9, P = 0.048). Bulky regional lymphadenopathy is associated with a poor prognosis. Efforts to identify the ideal treatment regimen for these patients are urgently required.

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食管腺癌大块局部淋巴结病变对生存率的影响:单中心回顾性分析。
对于食管腺癌(EAC),尚未研究过 "大块 "局部淋巴结病变与生存之间的关系。本研究旨在探讨诊断时的大块区域淋巴结病是否会影响接受新辅助化疗和整体切除术的EAC患者的生存结果。2012年1月至2019年12月期间,对一个前瞻性维护的上消化道癌症手术数据库进行了单中心回顾性研究。确定了接受多西他赛为基础的新辅助化疗和经胸整体食管胃切除术的局部晚期EAC(cT2-3,N+,M0)患者。对开始治疗前的计算机断层扫描进行了复查,并根据是否存在大块局部区域淋巴结对患者进行了分层。淋巴结肿大的定义是任何轴线上的淋巴结肿大>2厘米。对总生存率进行了比较,并计算了 Cox 多元回归模型。在确定的 870 例患者中,有 225 例符合纳入标准。48人(21%)患有肿大淋巴结病,剩下的177人被分配到对照组。更多有肿大淋巴结病的患者患有 ypN3 疾病(18/48,38% 对 39/177,20%,P = 0.025)。在有肿大淋巴结病的患者中,总生存期普遍较短(32.6 个月 vs. 59.1 个月,P = 0.012)。然而,在9/48(19%)例淋巴结肿大患者中,获得ypN-状态的患者的生存结果与淋巴结未肿大但也获得淋巴结绝育的患者相似。分化不良(HR 1.8,95% CI 1.0-2.9,P = 0.034)、ypN+(HR 1.9,95% CI 1.1-3.6,P = 0.032)和肿大淋巴结病与死亡风险增加独立相关(HR 1.7,1.0-2.9,P = 0.048)。大块区域淋巴结病与预后不良有关。为这些患者确定理想的治疗方案迫在眉睫。
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来源期刊
Diseases of the Esophagus
Diseases of the Esophagus Medicine-Gastroenterology
自引率
7.70%
发文量
568
期刊介绍: Diseases of the Esophagus covers all aspects of the esophagus - etiology, investigation and diagnosis, and both medical and surgical treatment.
期刊最新文献
Reliability of symptoms for diagnosis and sling fiber preservation for prevention of GERD after POEM: is there a problem? Treatment of intrathoracic anastomotic leakage following esophagectomy for gastroesophageal cancer: a systematic review. Causes of death in locally advanced esophageal cancer undergoing neoadjuvant chemotherapy and neoadjuvant chemoradiotherapy: a retrospective cohort study. Letter to the editor: surgical treatment of esophago-tracheobronchial fistulas after esophagectomy. Tribute to Ikuo.
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