接受机器人辅助微创食管切除术（RAMIE）治疗的食管癌多模式治疗后的淋巴结转移模式
Patterns of Lymph Node Metastases After Multimodality Therapy in Esophageal Carcinoma Treated with Robot-Assisted Minimally Invasive Esophagectomy (RAMIE).
作者
作者单位
- Department of Surgery, University Medical Center Utrecht, Utrecht, The Netherlands. M.E.Sanders-6@umcutrecht.nl.
- Department of Surgery, University Medical Center Utrecht, Utrecht, The Netherlands.
- Department of Radiology, University Medical Center Utrecht, Utrecht, The Netherlands.
- Department of Pathology, University Medical Center Utrecht, Utrecht, The Netherlands.
- Department of Medical Oncology, University Medical Center Utrecht, Utrecht, The Netherlands.
- Department of Radiation Oncology, University Medical Center Utrecht, Utrecht, The Netherlands.
摘要
中文
食管癌的淋巴结转移（LNM）表现出广泛且多变的播散。既往的定位研究局限于基于区域的报告、异质的分类系统以及缺乏当代多模式治疗队列。本研究旨在表征在标准化机器人辅助微创经胸食管切除术（RAMIE）和两野淋巴结清扫术后LNM的站级分布，并评估与关键术前参数相关的模式。分析了2018年至2024年间接受经胸RAMIE治疗腺癌（AC）或鳞状细胞癌（SCC）的前瞻性单中心观察队列。主要结局是LNM的站级分布，与组织学、肿瘤位置、临床T分期、临床N分期和新辅助治疗接受情况相关。分析为描述性。在210例患者（74% AC，26% SCC）中，中位淋巴结检出数为44（四分位距[IQR]，34-52）。42%的患者存在淋巴结转移，中位阳性淋巴结数为2（IQR，1-4）。尽管91%的患者接受了新辅助治疗（85% CROSS方案，7% FLOT方案），残余淋巴结疾病仍然常见且分布广泛。转移最常发生在食管旁（11%）、隆突下（10%）纵隔站，以及胃左动脉（22%）和右贲门旁（15%）淋巴结。9%的患者发现胸导管LNM。各术前参数的模式相似。32%的cN0患者观察到隐匿性淋巴结疾病。即使经过多模式治疗，食管癌的淋巴播散仍然广泛且不可预测。跨膈肌淋巴结受累在各亚组中的持续存在强调了系统性两野淋巴结清扫术对于实现最佳局部区域控制和准确病理分期的持续必要性。
English
Lymph node metastases (LNMs) in esophageal carcinoma demonstrate extensive and variable dissemination. Previous mapping studies are limited to region-based reporting, heterogeneous classification systems, and absence of contemporary multimodality-treated cohorts. This study aimed to characterize the station-level distribution of LNMs after standardized robot-assisted minimally invasive transthoracic esophagectomy (RAMIE) with two-field lymphadenectomy and to evaluate patterns in relation to key preoperative parameters. A prospective, single-center observational cohort of patients undergoing transthoracic RAMIE for adenocarcinoma (AC) or squamous cell carcinoma (SCC) between 2018 and 2024 was analyzed. The primary outcome was station-level distribution of LNMs in relation to histology, tumor location, clinical T stage, clinical N stage, and receipt of neoadjuvant therapy. Analyses were descriptive. Among 210 patients (74% AC, 26% SCC), median lymph node yield was 44 (interquartile range [IQR], 34-52). Lymph node metastases were present in 42% of the patients, with a median of two positive nodes (IQR, 1-4). Although 91% received neoadjuvant therapy (85% CROSS, 7% FLOT), residual nodal disease remained frequent and widely distributed. Metastases occurred most frequently in the paraesophageal (11%) subcarinal (10%) mediastinal stations, and along the left gastric artery (22%) and right paracardial (15%) nodes. Thoracic duct LNM was identified in 9% of the patients. Patterns were similar across preoperative parameters. Occult nodal disease was observed in 32% of cN0 patients. Lymphatic dissemination in esophageal cancer remains extensive and unpredictable, even after multimodality therapy. The persistence of cross-diaphragmatic nodal involvement across subgroups underscores the ongoing necessity of a systematic two-field lymphadenectomy to achieve optimal locoregional control and accurate pathologic staging.
分类与指标
- 研究类型
- 临床研究
- 病种
- 食管癌
- JCR 分区
- Q1
- 影响因子
- 3.8
- 新锐分区
- 2区