https://eutils.ncbi.nlm.nih.gov/entrez/eutils/efetch.fcgi?db=pubmed&id=38755542&retmode=xml&tool=Litmetric&email=readroberts32@gmail.com&api_key=61f08fa0b96a73de8c900d749fcb997acc09 387555422024051620240614
1471-24072412024May16BMC cancerBMC CancerExploration of lymph node recurrence patterns and delineation guidelines of radiation field in middle thoracic oesophageal carcinomas after radical surgery: a real-world study.59659659610.1186/s12885-024-12297-4Oesophageal squamous cell carcinoma is one of the most commonly diagnosed carcinomas in China, and postoperative radiotherapy plays an important role in improving the prognosis of patients. Carcinomas in different locations of the oesophagus could have different patterns of lymph node metastasis after surgery.In this multicentric retrospective study, we enrolled patients with middle thoracic oesophageal squamous cell carcinomas from 3 cancer centres, and none of the patients underwent radiotherapy before or after surgery. We analysed the lymph node recurrence rates in different stations to explore the postoperative lymphatic recurrence pattern.From January 1st, 2014, to December 31st, 2019, 132 patients met the criteria, and were included in this study. The lymphatic recurrence rate was 62.1%. Pathological stage (P = 0.032) and lymphadenectomy method (P = 0.006) were significant predictive factors of lymph node recurrence. The recurrence rates in the supraclavicular, upper and lower paratracheal stations of lymph nodes were 32.6%, 28.8% and 16.7%, respectively, showing a high incidence. The recurrence rate of the subcarinal node station was 9.8%, while 8.3% (upper, middle and lower) thoracic para-oesophageal nodes had recurrences.We recommend including the supraclavicular, upper and lower paratracheal stations of lymph nodes in the postoperative radiation field in middle thoracic oesophageal carcinomas. Subcarinal station is also potentially high-risk, while whether to include thoracic para-oesophageal or abdominal nodes needs careful consideration.© 2024. The Author(s).DuRongxuRKey laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Radiation Oncology, Peking University Cancer Hospital & Institute, Beijing, 100142, China.FanSongqingSOncology Division I, China Pingmei Shenma Medical Group General Hospital, Kuanggongzhong Rd.1, Xinhua District, Pingdingshan Henan, 450052, China.YangDanDKey laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Radiation Oncology, Peking University Cancer Hospital & Institute, Beijing, 100142, China.WangXiaobinXDepartment of Radiation Oncology, Hebei Cancer Hospital, The Fourth Hospital of Hebei Medical University, JianKang Rd.12, Shijiazhuang Hebei, 050011, China.HouXiaXDepartment of Radiation Oncology, Shanxi Provincial Cancer Hospital, No.3 Workers New Village, Xinghualing District, Taiyuan, Shanxi, 030013, China.ZengChengCDepartment of Radiation Oncology, Central Theater General Hospital, Wuluo Rd. 627, Wuchang District, Wuhan Hubei, 430061, China.GuoDanDDepartment of Radiation Oncology, Shanxi Provincial Cancer Hospital, No.3 Workers New Village, Xinghualing District, Taiyuan, Shanxi, 030013, China.TianRongrongRDepartment of Radiation Oncology, Shanxi Provincial Cancer Hospital, No.3 Workers New Village, Xinghualing District, Taiyuan, Shanxi, 030013, China.JiangLeileiLKey laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Radiation Oncology, Peking University Cancer Hospital & Institute, Beijing, 100142, China.DongXinXKey laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Radiation Oncology, Peking University Cancer Hospital & Institute, Beijing, 100142, China.YuRongRKey laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Radiation Oncology, Peking University Cancer Hospital & Institute, Beijing, 100142, China.YuHuimingHKey laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Radiation Oncology, Peking University Cancer Hospital & Institute, Beijing, 100142, China.ZhuShuchaiSDepartment of Radiation Oncology, Hebei Cancer Hospital, The Fourth Hospital of Hebei Medical University, JianKang Rd.12, Shijiazhuang Hebei, 050011, China. sczhu1965@163.com.LiJieJDepartment of Radiation Oncology, Shanxi Provincial Cancer Hospital, No.3 Workers New Village, Xinghualing District, Taiyuan, Shanxi, 030013, China. lijie942003@163.com.ShiAnhuiAKey laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Radiation Oncology, Peking University Cancer Hospital & Institute, Beijing, 100142, China. anhuidoctor@163.com.engY-2019AZMS-0519CSCO grantJournal ArticleMulticenter Study20240516
EnglandBMC Cancer1009678001471-2407IMHumansMaleFemaleMiddle AgedEsophageal NeoplasmspathologyradiotherapysurgeryRetrospective StudiesLymphatic MetastasisNeoplasm Recurrence, LocalepidemiologypathologyAgedLymph NodespathologysurgeryLymph Node ExcisionEsophageal Squamous Cell CarcinomasurgerypathologyradiotherapyEsophagectomyAdultPrognosisChinaepidemiologyNeoplasm StagingMiddle thoracic oesophageal carcinomaPostoperative lymph node recurrenceRadiation fieldReal-world studyThe authors declare no competing interests.
2023921202442220245170442024517043202451623382024516epublish38755542PMC1109741410.1186/s12885-024-12297-410.1186/s12885-024-12297-4GLOBOCAN 2020. oesophagus cancer fact sheet [https://gco.iarc.fr/today/data/factsheets/cancers/6-Oesophagus-fact-sheet.pdf].Bray F, Ferlay J, Soerjomataram I, Siegel RL, Torre LA, Jemal A. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. Cancer J Clin. 2018;68(6):394–424. doi: 10.3322/caac.21492.10.3322/caac.2149230207593Chen W, Zheng R, Baade PD, Zhang S, Zeng H, Bray F, Jemal A, Yu XQ, He J. Cancer statistics in China, 2015. Cancer J Clin. 2016;66(2):115–32. doi: 10.3322/caac.21338.10.3322/caac.2133826808342Torre LA, Siegel RL, Ward EM, Jemal A. Global cancer incidence and mortality rates and trends–an update. Cancer Epidemiol Biomark Prev. 2016;25(1):16–27. doi: 10.1158/1055-9965.EPI-15-0578.10.1158/1055-9965.EPI-15-057826667886Zhang Y. Epidemiology of esophageal cancer. World J Gastroenterol. 2013;19(34):5598–606. doi: 10.3748/wjg.v19.i34.5598.10.3748/wjg.v19.i34.5598PMC376989524039351Forastiere AA. Multimodality treatment of esophagus cancer: current status and future perspectives in the United States. Esophagus. 2010;7(1):1–6. doi: 10.1007/s10388-009-0226-8.10.1007/s10388-009-0226-8Hertier. multi-directional interpretation of esophageal cancer standardized diagnosis and treatment [http://news.medlive.cn/cancer/info-progress/show-40985_53.html].Chen J, Pan J, Zheng X, Zhu K, Li J, Chen M, Wang J, Liao Z. Number and location of positive nodes, postoperative radiotherapy, and survival after esophagectomy with three-field lymph node dissection for thoracic esophageal squamous cell carcinoma. Int J Radiat Oncol Biol Phys. 2012;82(1):475–82. doi: 10.1016/j.ijrobp.2010.08.037.10.1016/j.ijrobp.2010.08.03720934269Wong AT, Shao M, Rineer J, Lee A, Schwartz D, Schreiber D. The impact of adjuvant postoperative radiation therapy and chemotherapy on survival after esophagectomy for esophageal carcinoma. Ann Surg. 2017;265(6):1146–51. doi: 10.1097/SLA.0000000000001825.10.1097/SLA.000000000000182527280504Worni M, Martin J, Gloor B, Pietrobon R, D’Amico TA, Akushevich I, Berry MF. Does surgery improve outcomes for esophageal squamous cell carcinoma? An analysis using the surveillance epidemiology and end results registry from 1998 to 2008. J Am Coll Surg. 2012;215(5):643–51. doi: 10.1016/j.jamcollsurg.2012.07.006.10.1016/j.jamcollsurg.2012.07.006PMC347943323084493Zou B, Pang J, Liu Y, Xu Y, Li L, Zhou L, Zhu J, Huang M, Wang J, Ren L, et al. Postoperative chemoradiotherapy improves survival in patients with stage II-III esophageal squamous cell carcinoma: an analysis of clinical outcomes. Thorac cancer. 2016;7(5):515–21. doi: 10.1111/1759-7714.12355.10.1111/1759-7714.12355PMC512916527766781Wang S, Wang Z, Yang Z, Liu Y, Liu X, Shang B, Jiang WP. Postoperative radiotherapy improves survival in stage pT2N0M0 esophageal squamous cell carcinoma with high risk of poor prognosis. Ann Surg Oncol. 2016;23(1):265–72. doi: 10.1245/s10434-015-4622-0.10.1245/s10434-015-4622-026014154Yu J, Ouyang W, Li Y, Hu J, Xu Y, Wei Y, Liao Z, Liu Y, Zhang J, Xie C. Value of radiotherapy in addition to esophagectomy for stage II and III thoracic esophageal squamous cell carcinoma: analysis of surveillance, epidemiology, and end results database. Cancer Med. 2019;8(1):21–7. doi: 10.1002/cam4.1731.10.1002/cam4.1731PMC634625430561117Chinese Guidelines for Radiotherapy of Esophageal Cancer. Journal of International Oncology, 2022. 2022;49(11):641–657.Rice TW, Ishwaran H, Ferguson MK, Blackstone EH, Goldstraw P. Cancer of the esophagus and esophagogastric junction: an eighth edition staging primer. J Thorac Oncology: Official Publication Int Association Study Lung Cancer. 2017;12(1):36–42. doi: 10.1016/j.jtho.2016.10.016.10.1016/j.jtho.2016.10.016PMC559144327810391Nagaki Y, Motoyama S, Sato Y, Wakita A, Fujita H, Kemuriyama K, Sasaki Y, Imai K, Maeda E, Minamiya Y. PET-uptake reduction into lymph nodes after neoadjuvant therapy is highly predictive of prognosis for patients who have thoracic esophageal squamous cell carcinoma treated with chemoradiotherapy plus esophagectomy. Ann Surg Oncol. 2022;29(2):1336–46. doi: 10.1245/s10434-021-10564-3.10.1245/s10434-021-10564-334355333Kawamoto T, Nihei K, Sasai K, Karasawa K. Clinical outcomes and prognostic factors of chemoradiotherapy for postoperative lymph node recurrence of esophageal cancer. Jpn J Clin Oncol. 2018;48(3):259–64. doi: 10.1093/jjco/hyx171.10.1093/jjco/hyx17129190352Xu Z-C, Su B-A. Comparison of local recurrence patterns of postoperative radiotherapy with surgery alone for esophageal carcinoma patients. J Surg Oncol. 2021;6(1):33–40.Li J, Qiu R, Hu Y, Wang Y, Qi Z, He M, Li Y. Postoperative adjuvant therapy for patients with pN + esophageal squamous cell carcinoma. BioMed research international. 2021;2021:8571438.PMC784734233553432Ni W, Chen J, Xiao Z, Yu S, Zhang W, Zhou Z, Chen D, Feng Q, Chen X, Lin Y, et al. Adjuvant radiotherapy for stage pN1M0 esophageal squamous cell carcinoma: results from a Chinese two-center study. Thorac cancer. 2019;10(6):1431–40. doi: 10.1111/1759-7714.13088.10.1111/1759-7714.13088PMC655850531102336Li L, Zhao L, Lin B, Su H, Su M, Xie D, Jin X, Xie C. Adjuvant therapeutic modalities following three-field lymph node dissection for stage II/III esophageal squamous cell carcinoma. J Cancer. 2017;8(11):2051–9. doi: 10.7150/jca.18981.10.7150/jca.18981PMC555996728819406Du R, Fan S, Wang X, Hou X, Zeng C, Guo D, Tian R, Yang D, Jiang L, Dong X, et al. Postoperative lymphatic recurrence distribution and delineation of the radiation field in lower thoracic squamous cell esophageal carcinomas: a real-world study. Radiation Oncol (London England) 2022;17(1):47. doi: 10.1186/s13014-022-01987-7.10.1186/s13014-022-01987-7PMC889842135248100Zhang Y, Gao J, Zheng A, Yang H, Li J, Wu S, Zhao J, Meng P, Zhou F. Definition and risk factors of early recurrence based on affecting prognosis of esophageal squamous cell carcinoma patients after radical resection. Translational Oncol. 2021;14(6):101066. doi: 10.1016/j.tranon.2021.101066.10.1016/j.tranon.2021.101066PMC798556033744728Huang W, Li B, Gong H, Yu J, Zhou T, Sun H, Zhang Z, Liu X. Pattern of lymph node metastases and its implication in radiotherapeutic clinical target volume in patients with thoracic esophageal squamous cell carcinoma: a report of 1077 cases. Radiother Oncol. 2010;95(2):229–33. doi: 10.1016/j.radonc.2010.01.006.10.1016/j.radonc.2010.01.00620189259Chen W, Sun K, Zheng R, Zeng H, Zhang S, Xia C, Yang Z, Li H, Zou X, He J. Cancer incidence and mortality in China, 2014. Chin J cancer Res = Chung-kuo Yen Cheng Yen Chiu. 2018;30(1):1–12. doi: 10.21147/j.issn.1000-9604.2018.01.01.10.21147/j.issn.1000-9604.2018.01.01PMC584222329545714Wu AJ, Bosch WR, Chang DT, Hong TS, Jabbour SK, Kleinberg LR, Mamon HJ, Thomas CR, Jr, Goodman KA. Expert consensus contouring guidelines for intensity modulated radiation therapy in esophageal and gastroesophageal junction cancer. Int J Radiat Oncol Biol Phys. 2015;92(4):911–20. doi: 10.1016/j.ijrobp.2015.03.030.10.1016/j.ijrobp.2015.03.030PMC448132526104943Law SY, Fok M, Wong J. Pattern of recurrence after oesophageal resection for cancer: clinical implications. Br J Surg. 1996;83(1):107–11. doi: 10.1002/bjs.1800830134.10.1002/bjs.18008301348653330Katayama A, Mafune K, Tanaka Y, Takubo K, Makuuchi M, Kaminishi M. Autopsy findings in patients after curative esophagectomy for esophageal carcinoma. J Am Coll Surg. 2003;196(6):866–73. doi: 10.1016/S1072-7515(03)00116-9.10.1016/S1072-7515(03)00116-912788422Nakagawa S, Kanda T, Kosugi S, Ohashi M, Suzuki T, Hatakeyama K. Recurrence pattern of squamous cell carcinoma of the thoracic esophagus after extended radical esophagectomy with three-field lymphadenectomy. J Am Coll Surg. 2004;198(2):205–11. doi: 10.1016/j.jamcollsurg.2003.10.005.10.1016/j.jamcollsurg.2003.10.00514759776Yasuda T, Yano M, Miyata H, Yamasaki M, Takiguchi S, Fujiwara Y, Doki Y. Evaluation of dysphagia and diminished airway protection after three-field esophagectomy and a remedy. World J Surg. 2013;37(2):416–23. doi: 10.1007/s00268-012-1822-7.10.1007/s00268-012-1822-723052815Yamashita K, Watanabe M, Mine S, Kurogochi T, Okamura A, Hayami M, Imamura Y. Patterns and outcomes of recurrent esophageal cancer after curative esophagectomy. World J Surg. 2017;41(9):2337–44. doi: 10.1007/s00268-017-4024-5.10.1007/s00268-017-4024-528432391Li B, Hu H, Zhang Y, Zhang J, Miao L, Ma L, Luo X, Zhang Y, Ye T, Li H. Three-field versus two‐field lymphadenectomy in transthoracic oesophagectomy for oesophageal squamous cell carcinoma: short‐term outcomes of a randomized clinical trial. Br J Surg 2020, 107.32108326Akiyama H, Tsurumaru M, Udagawa H, Kajiyama Y. Radical lymph node dissection for cancer of the thoracic esophagus. Ann Surg. 1994;220(3):364–72. doi: 10.1097/00000658-199409000-00012.10.1097/00000658-199409000-00012PMC12343948092902Fujita H, Kakegawa T, Yamana H, Shima I, Toh Y, Tomita Y, Fujii T, Yamasaki K, Higaki K, Noake T. Mortality and morbidity rates, postoperative course, quality of life, and prognosis after extended radical lymphadenectomy for esophageal cancer. Comparison of three-field lymphadenectomy with two-field lymphadenectomy. Ann Surg. 1995;222(5):654–62. doi: 10.1097/00000658-199511000-00008.10.1097/00000658-199511000-00008PMC12349937487213Davies AR, Pillai A, Sinha P, Sandhu H, Adeniran A, Mattsson F, Choudhury A, Forshaw MJ, Gossage JA, Lagergren J, et al. Factors associated with early recurrence and death after esophagectomy for cancer. J Surg Oncol. 2014;109(5):459–64. doi: 10.1002/jso.23511.10.1002/jso.2351124301461Zhu ZJ, Hu Y, Zhao YF, Chen XZ, Chen LQ, Chen YT. Early recurrence and death after esophagectomy in patients with esophageal squamous cell carcinoma. Ann Thorac Surg. 2011;91(5):1502–8. doi: 10.1016/j.athoracsur.2011.01.007.10.1016/j.athoracsur.2011.01.00721354552Jiang KY, Huang H, Chen WY, Yan HJ, Wei ZT, Wang XW, Li HX, Zheng XY, Tian D. Risk factors for lymph node metastasis in T1 esophageal squamous cell carcinoma: a systematic review and meta-analysis. World J Gastroenterol. 2021;27(8):737–50. doi: 10.3748/wjg.v27.i8.737.10.3748/wjg.v27.i8.737PMC793400333716451