Clinical N category (cN) is generally assessed by measuring the nodal diameter by CT before the initiation of primary treatment in esophageal squamous cell carcinoma (ESCC). The short-axis diameter is recommended for evaluating treatment response in solid tumors by RECIST. This study aimed to elucidate the prognostic implication of the maximum short-axis diameter of lymph node (cN-size) before preoperative chemotherapy for ESCC. Methods We enrolled a total of 152 patients who underwent preoperative cisplatin/5-fluorouracil therapy (CF) followed by esophagectomy from 2005 to 2011. There were 127 men and 25 women with a median age of 65 years (range: 47–79 years). Clinically metastatic node was defined as follows; the node with cN-size ≥10 mm or that with 5 mm ≤ cN-size <10 mm and contrast enhancement, round shape and/or central necrosis in CT before starting CF. The association between the maximum cN-size and the overall survival (OS) after surgery was statistically investigated. The median follow-up period was 87 months (range: 36–145 months). Results The number of patients with cN0 and cN1–3 was 60 and 92, respectively. Twenty-seven and 65 patients with cN1–3 were classified into cN-size <10 mm and cN-size ≥10 mm group, respectively. The 5-year OS rates in cN0, cN-size <10 mm and cN-size ≥10 mm groups were 70%, 51% and 45%, respectively (P = 0.006). Among Ut-Mt tumors, the OS in the cN-size <10 mm group was significantly worse than that in the cN0 group (5-year OS rate: 45% vs. 74%, P = 0.048). However, there were no significant differences in the OS between these two groups in Lt tumors (67% vs. 64%, P = 0.789). Conclusion The maximum short-axis diameter of lymph node before preoperative chemotherapy is significantly associated with OS in patients with ESCC. Lymph node with 5 mm ≤ cN-size <10 mm in the short axis should be treated as a metastatic node especially in Ut or Mt tumors, considering the poor prognosis.

中文翻译：

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116 短轴径对食管癌术前化疗前淋巴结评估的预后影响

临床 N 类 (cN) 通常通过在食管鳞状细胞癌 (ESCC) 的主要治疗开始前通过 CT 测量淋巴结直径来评估。RECIST 推荐使用短轴直径来评估实体瘤的治疗反应。本研究旨在阐明 ESCC 术前化疗前淋巴结最大短轴直径 (cN-size) 的预后意义。方法 我们共招募了 152 名在 2005 年至 2011 年间接受术前顺铂/5-氟尿嘧啶治疗 (CF) 随后进行食管切除术的患者。其中男性 127 名，女性 25 名，中位年龄为 65 岁（范围：47-79 岁） . 临床转移性淋巴结定义如下；cN尺寸≥10mm或5mm≤cN尺寸<10mm且对比度增强的节点，开始 CF 前 CT 呈圆形和/或中央坏死。统计学研究了最大 cN 大小与手术后总生存期 (OS) 之间的关联。中位随访期为 87 个月（范围：36-145 个月）。结果cN0和cN1-3患者分别为60例和92例。27 例和 65 例 cN1-3 患者分别被分为 cN 尺寸 <10 mm 和 cN 尺寸 ≥10 mm 组。cN0、cN-size <10 mm 和 cN-size ≥10 mm 组的 5 年 OS 率分别为 70%、51% 和 45% (P = 0.006)。在 Ut-Mt 肿瘤中，cN 大小 <10 mm 组的 OS 显着低于 cN0 组（5 年 OS 率：45% vs. 74%，P = 0.048）。然而，这两组在 Lt 肿瘤中的 OS 没有显着差异（67% 对 64%，P = 0.789）。结论术前化疗前淋巴结最大短轴径与ESCC患者OS显着相关。考虑到预后不良，短轴 5 mm ≤ cN 大小 <10 mm 的淋巴结应作为转移性淋巴结处理，尤其是在 Ut 或 Mt 肿瘤中。