淋巴结跳跃转移对T_xN_(>0)M_0分期原发性胸段食管鳞癌患者术后5年生存预测价值有限

Limited prognostic value of nodal skip metastasis for 5-year overall survival in patients with T_xN_(>0)M_0 esophageal squamous cell carcinoma after radical surgery

目的:探讨淋巴结跳跃转移(nodal skip metastasis,NSM)对食管鳞癌患者根治术后5年总生存期(overall survival,OS)的预测价值,并比较美国癌症联合会(AJCC/UICC)淋巴结转移分期(按个数)与日本食管疾病学会(JSED)淋巴结转移分期(按站数)对患者术后生存的预测价值。方法:回顾性分析2007年1月至2010年12月接受食管癌根治性手术、术后病理确诊为原发性胸段食管鳞癌、有淋巴结转移且无其他部位转移(T_xN_(>0)M_0)的356例患者的临床资料。356例患者中发生NSM 91例,占25.6%。采用log-rank生存分析及Cox多因素分析法分析影响患者术后5年OS的影响因素,并进行倾向性评分匹配(propensity score matching,PSM),评估NSM的预后意义。采用Cox模型及一致性指数(index of concordance,C-index)比较AJCC/UICC指南N分期与JSED指南N分期对患者术后生存的预测能力。结果:高龄、肿瘤位置、术后T分期、术后N分期(AJCC/UICC分期和JSED分期)是患者术后5年OS的预测因素(均P<0.05),而NSM不是患者术后5年OS的预测因素。Cox生存预测模型中,采用AJCC/UICC指南N分期对患者术后生存的预测能力(C-index=0.632)优于JSED指南N分期(C-index=0.620),两者联合的预测能力更高(C-index=0.635)。结论:对于术后分期TxN>0M0的胸段食管鳞癌患者,NSM可能不是术后5年OS的预测因素;基于AJCC/UICC指南N分期的生存预测模型对患者预后的预测能力优于JSED指南N分期。

Objective:To identify the prognostic value of nodal skip metastasis(NSM)for 5-year overall survival(OS)in the patients with esophageal squamous cell carcinoma(ESCC)after radical surgery,and to compare the predictive value of lymph node metastasis staging by two different criteria(AJCC/UICC and JSED)for the survival of patients after operation.Methods:The clinical data of 356 patients with primary thoracic ESCC,lymph node metastasis,and no other metastasis(T xN>0 M 0)confirmed by postoperative pathology from January 2007 to December 2010 were retrospectively analyzed.NSM occurred in 25.6%(91 cases)of 356 patients.Log-rank survival analysis and Cox multivariate analysis were used to seek the influencing factors of postoperative 5-year OS in patients.Then the tendency score matching(PSM)was further performed to evaluate the prognostic significance of NSM.Cox model and C-index were used to compare the predictive value of AJCC/UICC guideline and JSED guideline N staging for the survival of patients.Results:Baseline variables including age,tumor location,postoperative T-stage,postoperative N-stage(AJCC/UICC and JSED)were predictors of postoperative 5-year OS,whereas NSM was not.According to the Cox survival prediction model constructed above,if using both AJCC/UICC and JSED standards as two independent N staging variables,the prediction ability of AJCC/UICC standard(C-index=0.632)was better than that of JSED standard(C-index=0.620),and the combined predictive value was best(C-index=0.635).Conclusions:For the ESCC patients with postoperative staging T xN>0 M 0,NSM has no significant correlation with 5-year OS.In addition,the survival prediction model based on AJCC/UICC N staging is superior to that JSED N staging in predicting prognosis of patient with T xN>0 M 0 esophageal squamous cell carcinoma.