ASO：淋巴结跳跃性转移并非胸段食管鳞状细胞癌预后的预测因素

相关研究发现，淋巴结跳跃性转移(NSM)对于非小细胞肺癌具有重要的临床价值，但目前对食管癌NSM的相关研究较为匮乏。为此，我国复旦大学附属肿瘤医院相加庆副教授及付小龙教授等人进行了一项研究，该研究旨在筛选出影响NSM的风险因素，并对NSM在胸段食管鳞状细胞癌中的预后价值做出评价。该研究结果发表于2013年5月18日在线出版的《外科肿瘤学年鉴》(Annals of Surgical Oncology)杂志上。

该研究对207例胸段ESCC患者进行了考察，这些患者曾因淋巴结转移而接受过三野淋巴结清扫治疗。研究人员通过逻辑回归分析，对NSM发生情况与患者临床病理学特征及原发肿瘤间的关系进行了评价。此外，还通过对数秩检验及Cox回归分析，对NSM对患者总生存期(OS)的影响进行了评价。

研究人员发现，58 (26 %)例患者存在NSM。除原发肿瘤部位外，无其他因素与NSM发生率存在显著关联。该研究发现，有29例上胸段ESCC患者并不存在NSM，中段及下三分之一段食管部肿瘤发病率分别为38.9%及14.9 %。中位OS为30个月，此外，研究还发现，存在NSM及无NSM的患者间在OS方面并无显著差异(p = 0.767)。而通过Cox多变量分析后，仅发现N状态为OS的独立风险因素。

研究人员最终认为，胸段ESCC患者常见NSM，，尤其是肿瘤部位在食管中段或下三分之一段的患者。然而，NSM并非患者预后的预测因素。

Nodal Skip Metastasis is not a Predictor of Survival in Thoracic Esophageal Squamous Cell Carcinoma.
BACKGROUND
The presence of nodal skip metastasis (NSM) has been found to be of clinical importance in non-small cell lung cancer, but the study of this phenomenon in esophageal carcinoma is relatively rare. The purpose of this study was to identify risk factors influencing NSM and to assess its prognostic value in thoracic esophageal squamous cell carcinoma (ESCC).
METHODS
A total of 207 patients with thoracic ESCC who underwent three-field lymphadenectomy and who had lymph node metastasis were reviewed. Associations of NSM occurrence with the clinicopathological characteristics of patients and primary tumors were evaluated using logistic regression analysis. The influence of NSM on the overall survival (OS) was assessed by log-rank tests and Cox regression analysis.
RESULTS
NSM were present in 58 (26 %) patients. No factor was significantly associated with the incidence of NSM except for the location of primary tumor. There were no NSMs in the 29 patients from our study with upper thoracic ESCC, and the rates of tumors occurrence in the middle and lower third of the esophagus were 38.9 and 14.9 %, respectively. The median OS was 30 months, and no significant difference in OS was found between the patients with or without NSM (p = 0.767). Only N status was found to be the independent risk factor for OS by Cox multivariate analysis.
CONCLUSIONS
NSM is common in thoracic ESCC, especially in patients with tumors located in the middle and lower third of the esophagus. However, the presence of NSM did not predict prognosis.