1
|
Wang XY, Fu XY, Yang H, Wen J, Lin P, Fu JH. Clinical value of station 4R node dissection in esophageal squamous cell carcinoma. World J Surg Oncol 2023; 21:387. [PMID: 38110961 PMCID: PMC10726609 DOI: 10.1186/s12957-023-03280-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Accepted: 12/09/2023] [Indexed: 12/20/2023] Open
Abstract
BACKGROUND Many controversies still exist concerning the optimal extent of lymphadenectomy during esophagectomy in esophageal squamous cell carcinoma (ESCC). The objective of this study was to explore the characteristics of 4R metastasis and evaluate the clinical value of 4R node dissection in ESCC. METHODS A total of 736 ESCC patients who underwent radical esophagectomy between 2005 and 2013 were retrospectively collected, among which 393 ones underwent 4R dissection. Propensity score matching (PSM) method was applied to reduce the effects of confounding variables between the 4R dissection and non-dissection groups to analyze overall survival. RESULTS Patients showed a low 4R metastasis rate of 5.1% (20/393) (5.2%, 5.8%, and 1.8% for upper, middle, and lower tumors, respectively). Correlation analyses identified that 4R metastasis was significantly associated with station 2R metastasis (p < 0.001) and pathologic tumor-node-metastasis (pTNM) stage (p < 0.001). All 4R metastases were observed in stages IIIB and IVA. Moreover, patients with station 4R dissection failed to achieve significantly improved overall survival compared with those without 4R dissection, regardless of tumor stage (overall: p = 0.696; stage 0-IIIA: p = 0.317; stage IIIB-IVA: p = 0.619). CONCLUSION 4R metastasis is likely to be associated with more aggressive disease, and routine 4R node dissection might not be necessary for ESCC patients.
Collapse
Affiliation(s)
- Xin-Ye Wang
- Department of Thoracic Surgery, Sun Yat-Sen University Cancer Center, 651 Dongfeng Road East, Guangzhou, 510060, China
- Guangdong Esophageal Cancer Institute, Collaborative Innovation Centre of Cancer Medicine, State Key Laboratory of Oncology in South China, Guangzhou, 510060, China
| | - Xia-Yu Fu
- Department of Thoracic Surgery, Sun Yat-Sen University Cancer Center, 651 Dongfeng Road East, Guangzhou, 510060, China
- Guangdong Esophageal Cancer Institute, Collaborative Innovation Centre of Cancer Medicine, State Key Laboratory of Oncology in South China, Guangzhou, 510060, China
| | - Hong Yang
- Department of Thoracic Surgery, Sun Yat-Sen University Cancer Center, 651 Dongfeng Road East, Guangzhou, 510060, China
- Guangdong Esophageal Cancer Institute, Collaborative Innovation Centre of Cancer Medicine, State Key Laboratory of Oncology in South China, Guangzhou, 510060, China
| | - Jing Wen
- Department of Thoracic Surgery, Sun Yat-Sen University Cancer Center, 651 Dongfeng Road East, Guangzhou, 510060, China
- Guangdong Esophageal Cancer Institute, Collaborative Innovation Centre of Cancer Medicine, State Key Laboratory of Oncology in South China, Guangzhou, 510060, China
| | - Peng Lin
- Department of Thoracic Surgery, Sun Yat-Sen University Cancer Center, 651 Dongfeng Road East, Guangzhou, 510060, China
- Guangdong Esophageal Cancer Institute, Collaborative Innovation Centre of Cancer Medicine, State Key Laboratory of Oncology in South China, Guangzhou, 510060, China
| | - Jian-Hua Fu
- Department of Thoracic Surgery, Sun Yat-Sen University Cancer Center, 651 Dongfeng Road East, Guangzhou, 510060, China.
- Guangdong Esophageal Cancer Institute, Collaborative Innovation Centre of Cancer Medicine, State Key Laboratory of Oncology in South China, Guangzhou, 510060, China.
| |
Collapse
|
2
|
Tian D, Jiang KY, Yang YS, Yan HJ, Yu RX, Huang H, Jian SH, Zhou HN, Wen HY, Chen LQ. Pararespiratory and paradigestive lymph node metastases in esophageal squamous cell carcinoma: predicting survival and refining the N staging system. BMC Cancer 2023; 23:695. [PMID: 37488497 PMCID: PMC10367276 DOI: 10.1186/s12885-023-11055-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2022] [Accepted: 06/10/2023] [Indexed: 07/26/2023] Open
Abstract
BACKGROUND The site of lymph node metastasis (LNM) may affect the prognosis of patients with esophageal squamous cell carcinoma (ESCC). To investigate the prognoses of pararespiratory and paradigestive LNM and to propose a novel N (nN) staging system that integrates both the LNM site and count. METHODS This study was a multicenter, large-sample, retrospective cohort study that included ESCC patients with LNM between January 2014 and December 2019 from three Chinese institutes. Patients were set into training (two institutes) and external validation (one institute) cohorts. The primary outcomes were survival differences in LNM site and the development of novel nodal staging system. The overall survival (OS) of patients with pararespiratory LNM only (Group A), paradigestive LNM only (Group B), and both sites (Group C) was evaluated by Kaplan-Meier. Cox proportional hazards models were used to identify the independent prognostic factors. An nN staging system considering both the LNM site and count was developed and evaluated by the area under the receiver operating characteristic curve (AUC). RESULTS In total, 1313 patients were included and split into training (n = 1033) and external validation (n = 280) cohorts. There were 342 (26.0%), 568 (43.3%) and 403 (30.7%) patients in groups A, B and C, respectively. The OS of patients with pararespiratory and patients with paradigestive LNM presented significant differences in the training and validation cohorts (P < 0.050). In the training cohort, LNM site was an independent prognostic factor (hazard ratio: 1.58, 95% confidence intervals: 1.41-1.77, P < 0.001). The nN staging definition: nN1 (1-2 positive pararespiratory/paradigestive LNs), nN2 (3-6 pararespiratory LNs or 1 pararespiratory with 1paradigestive LN), nN3 (3-6 LNs with ≥ 1 paradigestive LN), nN4 (≥ 7 LNs). Subsets of patients with different nN stages showed significant differences in OS (P < 0.050). The prognostic model of the nN staging system presented higher performance in the training and validation cohorts at 3-year OS (AUC, 0.725 and 0.751, respectively) and 5-year OS (AUC, 0.740 and 0.793, respectively) than the current N staging systems. CONCLUSIONS Compared to pararespiratory LNM, the presence of paradigestive LNM is associated with worse OS. The nN staging system revealed superior prognostic ability than current N staging systems.
Collapse
Affiliation(s)
- Dong Tian
- Department of Thoracic Surgery, West China Hospital, Sichuan University, 37 Guoxue Alley, Chengdu, 610041, China
- Department of Cardiothoracic Intensive Care Unit, Affiliated Hospital of North Sichuan Medical College, Nanchong, 637000, China
| | - Kai-Yuan Jiang
- Department of Surgery, Tohoku University Graduate School of Medicine, Sendai, 980-8575, Japan
| | - Yu-Shang Yang
- Department of Thoracic Surgery, West China Hospital, Sichuan University, 37 Guoxue Alley, Chengdu, 610041, China
| | - Hao-Ji Yan
- College of Medical Imaging, North Sichuan Medical College, Nanchong, 637000, China
| | - Rui-Xuan Yu
- Department of Thoracic Oncology, Cancer Center, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Heng Huang
- Department of Cardiothoracic Intensive Care Unit, Affiliated Hospital of North Sichuan Medical College, Nanchong, 637000, China
| | - Shun-Hai Jian
- Department of Pathology, Affiliated Hospital of North Sichuan Medical College, Nanchong, 637000, China
| | - Hai-Ning Zhou
- Department of Thoracic Surgery, Suining Central Hospital, Suining, 629000, China
| | - Hong-Ying Wen
- Department of Cardiothoracic Intensive Care Unit, Affiliated Hospital of North Sichuan Medical College, Nanchong, 637000, China
| | - Long-Qi Chen
- Department of Thoracic Surgery, West China Hospital, Sichuan University, 37 Guoxue Alley, Chengdu, 610041, China.
| |
Collapse
|
3
|
Fu X, Fu J, Zhang X. ASO Author Reflection: Use of Endobronchial Ultrasound in the Evaluation of Recurrent Laryngeal Nerve Lymph Nodes in Esophageal Squamous Cell Carcinoma Patients. Ann Surg Oncol 2021; 28:3939-3940. [PMID: 33913047 DOI: 10.1245/s10434-020-09298-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Accepted: 10/15/2020] [Indexed: 11/18/2022]
Affiliation(s)
- Xiayu Fu
- Department of Thoracic Oncology, Sun Yat-sen University Cancer Centre, Guangzhou, China.,State Key Laboratory of Oncology in South China, Collaborative Innovation Centre of Cancer Medicine, Guangdong Esophageal Cancer Institute, Sun Yat-sen University Cancer Centre, Guangzhou, China
| | - Jianhua Fu
- Department of Thoracic Oncology, Sun Yat-sen University Cancer Centre, Guangzhou, China.,State Key Laboratory of Oncology in South China, Collaborative Innovation Centre of Cancer Medicine, Guangdong Esophageal Cancer Institute, Sun Yat-sen University Cancer Centre, Guangzhou, China
| | - Xu Zhang
- Department of Thoracic Oncology, Sun Yat-sen University Cancer Centre, Guangzhou, China. .,State Key Laboratory of Oncology in South China, Collaborative Innovation Centre of Cancer Medicine, Guangdong Esophageal Cancer Institute, Sun Yat-sen University Cancer Centre, Guangzhou, China.
| |
Collapse
|
4
|
Pu N, Gao S, Beckman R, Ding D, Wright M, Chen Z, Zhu Y, Hu H, Yin L, Beckman M, Thompson E, Hruban RH, Cameron JL, Gage MM, Lafaro KJ, Burns WR, Wolfgang CL, He J, Yu J, Burkhart RA. Defining a minimum number of examined lymph nodes improves the prognostic value of lymphadenectomy in pancreas ductal adenocarcinoma. HPB (Oxford) 2021; 23:575-586. [PMID: 32900612 DOI: 10.1016/j.hpb.2020.08.016] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 06/30/2020] [Accepted: 08/21/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Lymph node (LN) metastasis is associated with decreased survival following resection for pancreatic ductal adenocarcinoma (PDAC). In N0 disease, increasing total evaluated LN (ELN) correlates with improved outcomes suggesting patients may be understaged when LNs are undersampled. We aim to assess the optimal number of examined lymph nodes (ELN) following pancreatectomy. METHODS Data from 1837 patients undergoing surgery were prospectively collected. The binomial probability law was utilized to analyze the minimum number of examined LNs (minELN) and accurately characterize each histopathologic stage. LN ratio (LNR) was compared to American Joint Committee on Cancer (AJCC) guidelines. RESULTS As ELN total increased, the likelihood of finding node positive disease increased. An evaluation based upon the binomial probability law suggested an optimal minELN of 12 for accurate AJCC N staging. As the number of ELNs increased, the discriminatory capacity of alternative strategies to characterize LN disease exceeded that offered by AJCC N stage. CONCLUSION This is the first study dedicated to optimizing histopathologic staging in PDAC using models of minELN informed by the binomial probability law. This study highlights two separate cutoffs for ELNs depending upon prognostic goal and validates that 12 LNs are adequate to determine AJCC N stage for the majority of patients.
Collapse
Affiliation(s)
- Ning Pu
- Division of Hepatobiliary and Pancreatic Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Department of General Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Shanshan Gao
- Division of Hepatobiliary and Pancreatic Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Department of Interventional Radiology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Ross Beckman
- Division of Hepatobiliary and Pancreatic Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Ding Ding
- Division of Hepatobiliary and Pancreatic Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Michael Wright
- Division of Hepatobiliary and Pancreatic Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Zhiyao Chen
- Division of Hepatobiliary and Pancreatic Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Yayun Zhu
- Division of Hepatobiliary and Pancreatic Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Haijie Hu
- Division of Hepatobiliary and Pancreatic Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Lingdi Yin
- Division of Hepatobiliary and Pancreatic Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Michael Beckman
- Division of Hepatobiliary and Pancreatic Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Elizabeth Thompson
- Department of Pathology, The Sol Goldman Pancreatic Cancer Research Center and The Pancreatic Cancer Precision Medicine Program of Excellence, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Ralph H Hruban
- Department of Pathology, The Sol Goldman Pancreatic Cancer Research Center and The Pancreatic Cancer Precision Medicine Program of Excellence, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - John L Cameron
- Division of Hepatobiliary and Pancreatic Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Department of Oncology, The Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Michele M Gage
- Division of Hepatobiliary and Pancreatic Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Department of Oncology, The Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Kelly J Lafaro
- Division of Hepatobiliary and Pancreatic Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Department of Oncology, The Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - William R Burns
- Division of Hepatobiliary and Pancreatic Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Department of Oncology, The Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Christopher L Wolfgang
- Division of Hepatobiliary and Pancreatic Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Department of Pathology, The Sol Goldman Pancreatic Cancer Research Center and The Pancreatic Cancer Precision Medicine Program of Excellence, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Department of Oncology, The Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Jin He
- Division of Hepatobiliary and Pancreatic Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Department of Oncology, The Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Jun Yu
- Division of Hepatobiliary and Pancreatic Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Department of Oncology, The Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
| | - Richard A Burkhart
- Division of Hepatobiliary and Pancreatic Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Department of Oncology, The Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
| |
Collapse
|
5
|
Fu X, Wang F, Su X, Luo G, Lin P, Rong T, Xu G, Zhang R, Wang X, Lin Y, Fu J, Zhang X. Endobronchial Ultrasound Improves Evaluation of Recurrent Laryngeal Nerve Lymph Nodes in Esophageal Squamous Cell Carcinoma Patients. Ann Surg Oncol 2020; 28:3930-3938. [PMID: 33249523 DOI: 10.1245/s10434-020-09241-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2020] [Accepted: 09/28/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND The bilateral recurrent laryngeal nerve (RLN) lymph nodes are the most common metastatic site for esophageal squamous cell carcinoma (ESCC); however, the RLNs are susceptible to injury during dissection. Clinically, there is an urgent need to determine an effective diagnostic method for RLN nodes to help achieve selective nodal dissection and avoid potential serious complications by performing more conservative surgery for those with nonmetastatic nodes. Here, we innovatively applied endobronchial ultrasonography (EBUS) and investigated its diagnostic performance for preoperative evaluation of RLN nodes in ESCC patients. PATIENTS AND METHODS All 81 enrolled ESCC patients underwent preoperative EBUS and CT examinations. The ability of EBUS and CT to detect RLN node metastasis was evaluated based on the resulting sensitivity, specificity, accuracy, positive predictive value (PPV), and negative predictive value (NPV). RESULTS The diagnostic performance of EBUS was superior to that of CT; in particular, EBUS of the left RLN (L-RLN) nodes presented the best sensitivity, specificity, PPV, NPV, and accuracy compared with EBUS evaluations of the right RLN (R-RLN) nodes, CT of the L-RLN and R-RLN nodes. Moreover, EBUS combined with CT increased the NPV relative to that of EBUS or CT alone, promoting the ability to identify true-negative RLN nodes. In particular, the NPVs of the combined modality were 100% for both the L- and R-RLN nodes in early-T-stage (T1-T2) ESCC. CONCLUSIONS EBUS is an efficient tool for RLN node evaluation, and the combination with CT may provide better guidance for selective RLN node dissection in ESCC patients.
Collapse
Affiliation(s)
- Xiayu Fu
- Department of Thoracic Surgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.,Department of Thoracic Oncology, Sun Yat-sen University Cancer Centre, Guangzhou, China.,Guangdong Esophageal Cancer Institute, Collaborative Innovation Centre of Cancer Medicine, State Key Laboratory of Oncology in South China, Guangzhou, China
| | - Feixiang Wang
- Department of Thoracic Oncology, Affiliated Cancer Hospital and Institute of Guangzhou Medical University, Guangzhou, China.,Guangdong Esophageal Cancer Institute, Collaborative Innovation Centre of Cancer Medicine, State Key Laboratory of Oncology in South China, Guangzhou, China
| | - Xiaodong Su
- Department of Thoracic Oncology, Sun Yat-sen University Cancer Centre, Guangzhou, China.,Guangdong Esophageal Cancer Institute, Collaborative Innovation Centre of Cancer Medicine, State Key Laboratory of Oncology in South China, Guangzhou, China
| | - Guangyu Luo
- Department of Endoscopy, Sun Yat-sen University Cancer Centre, Guangzhou, China.,Guangdong Esophageal Cancer Institute, Collaborative Innovation Centre of Cancer Medicine, State Key Laboratory of Oncology in South China, Guangzhou, China
| | - Peng Lin
- Department of Thoracic Oncology, Sun Yat-sen University Cancer Centre, Guangzhou, China.,Guangdong Esophageal Cancer Institute, Collaborative Innovation Centre of Cancer Medicine, State Key Laboratory of Oncology in South China, Guangzhou, China
| | - Tiehua Rong
- Department of Thoracic Oncology, Sun Yat-sen University Cancer Centre, Guangzhou, China.,Guangdong Esophageal Cancer Institute, Collaborative Innovation Centre of Cancer Medicine, State Key Laboratory of Oncology in South China, Guangzhou, China
| | - Guoliang Xu
- Department of Endoscopy, Sun Yat-sen University Cancer Centre, Guangzhou, China.,Guangdong Esophageal Cancer Institute, Collaborative Innovation Centre of Cancer Medicine, State Key Laboratory of Oncology in South China, Guangzhou, China
| | - Rong Zhang
- Department of Endoscopy, Sun Yat-sen University Cancer Centre, Guangzhou, China.,Guangdong Esophageal Cancer Institute, Collaborative Innovation Centre of Cancer Medicine, State Key Laboratory of Oncology in South China, Guangzhou, China
| | - Xinye Wang
- Department of Thoracic Oncology, Sun Yat-sen University Cancer Centre, Guangzhou, China.,Guangdong Esophageal Cancer Institute, Collaborative Innovation Centre of Cancer Medicine, State Key Laboratory of Oncology in South China, Guangzhou, China
| | - Yaobin Lin
- Department of Thoracic Oncology, Sun Yat-sen University Cancer Centre, Guangzhou, China.,Guangdong Esophageal Cancer Institute, Collaborative Innovation Centre of Cancer Medicine, State Key Laboratory of Oncology in South China, Guangzhou, China
| | - Jianhua Fu
- Department of Thoracic Oncology, Sun Yat-sen University Cancer Centre, Guangzhou, China. .,Guangdong Esophageal Cancer Institute, Collaborative Innovation Centre of Cancer Medicine, State Key Laboratory of Oncology in South China, Guangzhou, China.
| | - Xu Zhang
- Department of Thoracic Oncology, Sun Yat-sen University Cancer Centre, Guangzhou, China. .,Guangdong Esophageal Cancer Institute, Collaborative Innovation Centre of Cancer Medicine, State Key Laboratory of Oncology in South China, Guangzhou, China.
| |
Collapse
|
6
|
Yuan Y, Hong HG, Zeng X, Xu LY, Yang YS, Shang QX, Yang H, Li Y, Li Y, Wu ZY, Fu JH, Yao XD, Xu XE, Wu JY, Chen LQ. Lymph Node Station-Based Nodal Staging System for Esophageal Squamous Cell Carcinoma: A Large-Scale Multicenter Study. Ann Surg Oncol 2019; 26:4045-4052. [DOI: 10.1245/s10434-019-07601-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2018] [Indexed: 12/30/2022]
|
7
|
Xie X, Luo K, Li Y, Ling Y, Zhang S, Xie X, Wen J. Histone deacetylase 6 expression in metastatic lymph nodes is a valuable prognostic marker for resected node-positive esophageal squamous cell cancer. Cancer Manag Res 2018; 10:5451-5460. [PMID: 30519093 PMCID: PMC6234999 DOI: 10.2147/cmar.s178575] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
Background Histone deacetylase 6 (HDAC6) exerts enzymatic deacetylation activity on histones and on non-histone substrates and plays a key role in microtubule dynamics and chaperone activities. In addition, previous studies have demonstrated its role in cancer progression. However, its clinical significance in esophageal squamous cell cancer (ESCC) has not been elucidated. We investigated the correlation of HDAC6 expression and clinical outcome in a group of T3N1–3M0 surgically resected ESCCs. Methods Tissue microarrays were conducted on 209 surgically resected T3N1–3M0 ESCC tumors, including 163 pairs of primary tumors (PTs) and their corresponding metastatic lymph nodes (MLNs). Immunohistochemistry was utilized to evaluate HDAC6 protein levels. The relationship between patient outcomes and HDAC6 expression was analyzed statistically. Results The level of HDAC6 expression in ESCC MLNs was found to be significantly lower than that in PTs (P<0.001). Patients with lower MLN HDAC6 expression demonstrated improved overall survival (P=0.011) and disease-free survival (P=0.012) than those with higher HDAC6 expression. HDAC6 expression levels in PTs revealed no prognostic significance. Multivariate analysis showed that the MLN HDAC6 expression level was an independent prognostic factor for both overall survival (HR 1.456, P=0.029) and disease-free survival (HR 1.432, P=0.033). Conclusion High expression of HDAC6 in MLNs but not in PTs suggests a poor prognosis for patients with resected T3N1–3M0 ESCC. We should take into account the protein expression of MLNs when assessing prognosis in patients with lymph-node involvement.
Collapse
Affiliation(s)
- Xuan Xie
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, People's Republic of China.,Department of Thoracic Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, People's Republic of China
| | - Kongjia Luo
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, People's Republic of China, .,Guangdong Esophageal Cancer Research Institute, Guangzhou, People's Republic of China, .,Department of Thoracic Surgery, Sun Yat-sen University Cancer Center, Guangzhou, People's Republic of China
| | - Yi Li
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, People's Republic of China, .,Guangdong Esophageal Cancer Research Institute, Guangzhou, People's Republic of China, .,Department of Anesthesiology, Sun Yat-sen University Cancer Center, Guangzhou, People's Republic of China
| | - Yihong Ling
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, People's Republic of China, .,Guangdong Esophageal Cancer Research Institute, Guangzhou, People's Republic of China, .,Department of Pathology, Sun Yat-sen University Cancer Center, Guangzhou, People's Republic of China
| | - Shuishen Zhang
- Department of Thoracic Surgery, the First Affiliated Hospital, Sun Yat-sen University, Guangzhou, People's Republic of China
| | - Xiuying Xie
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, People's Republic of China, .,Guangdong Esophageal Cancer Research Institute, Guangzhou, People's Republic of China,
| | - Jing Wen
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, People's Republic of China, .,Guangdong Esophageal Cancer Research Institute, Guangzhou, People's Republic of China,
| |
Collapse
|
8
|
Yang YS, Hu WP, Wang WP, Yuan Y, Chen LQ. Prognostic power of lymph node station ratio for resected esophageal squamous cell carcinoma patients deserves additional investigation. J Surg Oncol 2018; 118:49. [PMID: 29878353 DOI: 10.1002/jso.25084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2018] [Accepted: 01/09/2018] [Indexed: 02/05/2023]
Affiliation(s)
- Yu-Shang Yang
- Department of Thoracic Surgery, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Wei-Peng Hu
- Department of Thoracic Surgery, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Wen-Ping Wang
- Department of Thoracic Surgery, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Yong Yuan
- Department of Thoracic Surgery, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Long-Qi Chen
- Department of Thoracic Surgery, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| |
Collapse
|
9
|
Li H, Fang W, Yu Z, Mao Y, Chen L, He J, Rong T, Chen C, Chen H, Chen K, Du M, Han Y, Hu J, Fu J, Hou X, Gong T, Li Y, Liu J, Liu S, Tan L, Tian H, Wang Q, Xiang J, Xu M, Ye X, You B, Zhang R, Zhao Y. Chinese expert consensus on mediastinal lymph node dissection in esophagectomy for esophageal cancer (2017 edition). J Thorac Dis 2018; 10:2481-2489. [PMID: 29850156 DOI: 10.21037/jtd.2018.03.175] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Affiliation(s)
- Hui Li
- Department of Thoracic Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing 100020, China
| | - Wentao Fang
- Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiaotong University Medical School, Shanghai 200030, China
| | - Zhentao Yu
- Department of Esophageal Oncology, Tianjin Medical University Cancer Institute & Hospital, Tianjin 300060, China
| | - Yousheng Mao
- Department of Thoracic Surgery, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021,China
| | - Longqi Chen
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Jie He
- Department of Thoracic Surgery, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Tiehua Rong
- Department of Thoracic Surgery, San Yat-sen University Cancer Center, Guangzhou 510060, China
| | - Chun Chen
- Department of Thoracic Surgery, Fujian Medical University Union Hospital, Fujian 350001, China
| | - Haiquan Chen
- Department of Thoracic Surgery, Cancer Hospital, Fudan University, Shanghai 200032, China
| | - Keneng Chen
- Department of Thoracic Surgery, Beijing University Cancer Center, Beijing 100142, China
| | - Ming Du
- Department of Thoracic Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
| | - Yongtao Han
- Department of Thoracic Surgery, Sichuan Cancer Hospital and Institute, Chengdu 610041, China
| | - Jian Hu
- Department of Thoracic Surgery, First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310003, China
| | - Jianhua Fu
- Department of Thoracic Surgery, San Yat-sen University Cancer Center, Guangzhou 510060, China
| | - Xiaobin Hou
- Department of Thoracic Surgery, Chinese PLA General Hospital, Beijing 100853, China
| | - Taiqian Gong
- Department of Thoracic Surgery, Navy General Hospital of PLA, Beijing 100037, China
| | - Yin Li
- Department of Thoracic Surgery, Henan Cancer Hospital, Zhengzhou 450008, China
| | - Junfeng Liu
- Department of Thoracic Surgery, The Fourth Affiliated Hospital of Hebei Medical University, Shijiazhuang 050011, China
| | - Shuoyan Liu
- Department of Thoracic Surgery, Fujian Provincial Tumor Hospital, Fuzhou 350014, China
| | - Lijie Tan
- Department of Thoracic Surgery, Shanghai Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Hui Tian
- Department of Thoracic Surgery, Qilu Hospital of Shandong University, Jinan 250012, China
| | - Qun Wang
- Department of Thoracic Surgery, Shanghai Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Jiaqing Xiang
- Department of Thoracic Surgery, Cancer Hospital, Fudan University, Shanghai 200032, China
| | - Meiqing Xu
- Department of Thoracic Surgery, The First Affiliated Hospital of University of Science and Technology of China (Anhui Provincial Hospital), Hefei 230001, China
| | | | | | - Renquan Zhang
- Department of Thoracic Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei 230022, China
| | - Yan Zhao
- Department of Thoracic Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing 100020, China
| | | |
Collapse
|
10
|
Wang WP, He SL, Yang YS, Chen LQ. Strategies of nodal staging of the TNM system for esophageal cancer. ANNALS OF TRANSLATIONAL MEDICINE 2018; 6:77. [PMID: 29666800 DOI: 10.21037/atm.2017.12.17] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
The 8th edition of UICC/AJCC TNM staging for esophageal cancer will start in use since 2018. The nodal staging in this version of TNM system remains unchanged from the 7th edition that based on the number of lymph nodes (LN) involved, except the limited revision of the regional LN map. In this review, N staging revision was evaluated from its initially simple definition of negative (N0) and positive (N1) LN(s) to the current positive node number based proposal. Meanwhile the disadvantages of current N staging were discussed. The refined nodal staging system in view of the number of metastatic node stations was introduced; as well as the extent and station of metastatic node could better reflect the disease progression and prognosis. The controversy on N staging of esophagogastric junction cancer was also discussed. Other reported N staging associated elements including LN ratio and lymphatic vessel invasion were reviewed and evaluated.
Collapse
Affiliation(s)
- Wen-Ping Wang
- Department of Thoracic Surgery, West China Hospital of Sichuan University, Chengdu 610041, China
| | - Song-Lin He
- Department of Thoracic Surgery, West China Hospital of Sichuan University, Chengdu 610041, China
| | - Yu-Shang Yang
- Department of Thoracic Surgery, West China Hospital of Sichuan University, Chengdu 610041, China
| | - Long-Qi Chen
- Department of Thoracic Surgery, West China Hospital of Sichuan University, Chengdu 610041, China
| |
Collapse
|