LYMPHOPARIETAL INDEX IN ESOPHAGEAL CANCER IS STRONGER THAN TNM STAGING IN LONG-TERM SURVIVAL PROGNOSIS IN A LATIN-AMERICAN COUNTRY

ABSTRACT Background: The identification of prognostic factors of esophageal cancer has allowed to predict the evolution of patients. Aim: Assess different prognostic factors of long-term survival of esophageal cancer and evaluate a new prognostic factor of long-term survival called lymphoparietal index (N+/T). Method: Prospective study of the Universidad de Chile Clinical Hospital, between January 2004 and December 2013. Included all esophageal cancer surgeries with curative intent and cervical anastomosis. Exclusion criteria included: stage 4 cancers, R1 resections, palliative procedures and emergency surgeries. Results: Fifty-eight patients were included, 62.1% were men, the average age was 63.3 years. A total of 48.3% were squamous, 88% were advanced cancers, the average lymph node harvest was 17.1. Post-operative surgical morbidity was 75%, with a 17.2% of reoperations and 3.4% of mortality. The average overall survival was 41.3 months, the 3-year survival was 31%. Multivariate analysis of the prognostic factors showed that significant variables were anterior mediastinal ascent (p=0.01, OR: 6.7 [1.43-31.6]), anastomotic fistula (p=0.03, OR: 0.21 [0.05-0.87]), N classification (p=0.02, OR: 3.8 [1.16-12.73]), TNM stage (p=0.04, OR: 2.8 [1.01-9.26]), and lymphoparietal index (p=0.04, RR: 3.9 [1.01-15.17]. The ROC curves of lymphoparietal index, N classification and TNM stage have areas under the curve of 0.71, 0.63 and 0.64 respectively, with significant statistical difference (p=0.01). Conclusion: The independent prognostic factors of long-term survival in esophageal cancer are anterior mediastinal ascent, anastomotic fistula, N classification, TNM stage and lymphoparietal index. In esophageal cancer the new lymphoparietal index is stronger than TNM stage in long-term survival prognosis.

摘要
研究背景：食管癌预后因素的识别可为患者病情转归的预测提供依据。
研究目的：评估影响食管癌长期生存的各类预后因素，并评价一种新型长期生存预后因素——淋巴壁指数（lymphoparietal index，N+/T）。
研究方法：本研究为前瞻性研究，数据取自智利大学临床医院，纳入2004年1月至2013年12月期间所有接受根治性颈部吻合食管癌手术的患者。排除标准包括IV期癌症、R1切除、姑息性手术及急诊手术患者。
研究结果：共纳入58例患者，其中男性占比62.1%，平均年龄63.3岁；48.3%为食管鳞状细胞癌，88%为进展期食管癌；平均清扫淋巴结数目为17.1枚。术后手术并发症发生率为75%，再次手术率为17.2%，术后死亡率为3.4%。患者平均总生存期为41.3个月，3年生存率为31%。多因素预后分析显示，具有统计学意义的预后相关变量包括：前纵隔受累（P=0.01，比值比OR=6.7，95%置信区间[1.43-31.6]）、吻合口瘘（P=0.03，OR=0.21，95%置信区间[0.05-0.87]）、N分期（P=0.02，OR=3.8，95%置信区间[1.16-12.73]）、TNM分期（P=0.04，OR=2.8，95%置信区间[1.01-9.26]）及淋巴壁指数（P=0.04，相对危险度RR=3.9，95%置信区间[1.01-15.17]）。淋巴壁指数、N分期及TNM分期的受试者工作特征曲线（Receiver Operating Characteristic，ROC）曲线下面积分别为0.71、0.63及0.64，组间差异具有统计学意义（P=0.01）。
研究结论：影响食管癌患者长期生存的独立预后因素包括前纵隔受累、吻合口瘘、N分期、TNM分期及淋巴壁指数。在食管癌患者中，新型淋巴壁指数的长期生存预测效能优于TNM分期。