Mapping Of Lymph Node Metastasis Of Thoracic Esophageal Cancer And Comparison Of Neoadjuvant Nab-paclitaxel Plus Immunotherapy Versus Paclitaxel Plus Immunotherapy For Esophageal Squamous Cell Carcinoma

Part Ⅰ Mapping of Lymph Node Metastasis From Thoracic Esophageal CancerObjectives:This retrospective study was designed to investigate the distribution of lymph node metastasis(LNM)in thoracic esophageal squamous cell carcinoma(ESCC)and superficial ESCC.The optimal extent of dissection for thoracic esophageal cancer(EC)was determined based on the incidence of lymph node metastasis(LNM).Methods:We retrospectively identified 1014 patients with thoracic ESCC who underwent esophagectomy at our institution from May 2018 to November 2020 and 181 cTIN0 stage ESCC cases with pathological positive lymph nodes(LNs)between February 2012 and April 2022,which were from ten esophageal cancer(EC)high-volume hospitals in China.Also,the location and rate of metastasis in routinely excised LNs were retrieved according to the postoperative pathological results and the Japan Esophageal Society(JES)staging system.Separately,we counted the metastasis rates of cTIN0 ESCC patients based on the depth of tumor invasion in subgroups.Results:A total of 1666 consecutive thoracic EC patients were screened,and 1014 ESCC patients were enrolled.Generally,the rates of LNM in thoracic EC may be arranged in the descending order of station 7>station 106recR>station 2>station 106recL.Esophageal cancer in the middle and lower thoracic segment also had a high rate of LNM along bilateral recurrent laryngeal nerve.Stations 106tbL and 111 were the lowest frequent sites of metastasis with rate less than 5%;only the patients with clinically positive LNs need to dissect.The cT34,cN+,or G3 were independent risk factors for LNM and neoadjuvant therapy did not change the distribution of LNM for thoracic EC cases.Of the 181 cTIN0 thoracic ESCC patients,20(11.0%)were diagnosed as pT1a cancer and 161(89.0%)as pT1b cancer by postoperative pathology.Generally,the LNM rates for pT1N+thoracic ESCC may be ordered as follows:station 106recR>station 106recL>station 1>station 7>station 2.And the study confirmed that the deeper the tumor invasion,the higher the LNM rate beside the bilateral recurrent laryngeal nerves(RLN).Conclusions:This study accurately identified the distribution of LNM for thoracic ESCC and superficial ESCC patients.The LNM of thoracic ESCC was jumping,and LNs beside RLN,left gastric artery and cardia were often positive.Specific location,LNM along stations 106recR(36.3%)and 106recL(25.6%)was often commonly observed in patients with superficial ESCC.Neoadjuvant therapy could not change the overall distribution of LNM in thoracic EC patients.However,whether LNs dissection at stations 106tbL and 111 is related to the survival of thoracic EC or not,needs a long follow-up time to verify.Part Ⅱ Comparison of neoadjuvant nab-paclitaxel plus immunotherapy versus paclitaxel plus immunotherapy for esophageal squamous cell carcinomaObjectives:This study aimed to compare the feasibility of nab-paclitaxel plus platinum-based chemotherapy(nabTP)versus paclitaxel plus platinum-based chemotherapy(TP)with immune checkpoint inhibitors(ICIs)as a neoadjuvant modality for locally resectable esophageal squamous cell carcinoma(ESCC).Methods:Between April 2019 and March 2022,we identified ESCC patients who received neoadjuvant immunotherapy with both nabTP(n=213)and TP(n=98)at our institution and Henan Cancer Hospital.The patients in the ICIs-nabTP and ICIs-TP groups were pair-matched(1:1)for tumor location,sex,smoking,drinking,clinical T and N stage.The primary endpoint was the hazard of 30-day major postoperative complications.Second,logistic models were applied to estimate the risk factors for pathological complete response(pCR)rate.Results:All patients underwent esophagectomy with R0 resection.A statistically significant increase in the risk of developing major pulmonary(odds ratio[OR],1.182;95%confidence interval[CI]:0.530-2.635;p=0.683),anastomotic(OR,1.881;95%CI:0.607-5.830;p=0.267),cardiac(OR,1.000;95%CI:0.426-2.349;p=1.000)complications after neoadjuvant immunotherapy plus nabTP was not observed.The median interval to surgery was 39 days in the ICIs-nabTP group versus 44 days in the ICIs-TP group(p=0.119).There was no 30-day mortality in each group.However,there was a slight difference in the 30-day readmission rate(p=0.043)and the incidence of hydropneumothorax(p=0.027)between the two groups.The pCR rates of the ICIs-nabTP and ICIs-TP group were 36.7 and 21.4%,respectively(p=0.018).Conclusions:It appears to be feasible to add immunotherapy to nabTP regimen for locally advanced ESCC.Compared with TP,nabTP plus ICIs can achieve a better pCR rate in ESCC.