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Chen TT, Yan HJ, He X, Fu SY, Zhang SX, Yang W, Zuo YJ, Tang HT, Yang JJ, Liu PZ, Wen HY, Tian D. A novel web-based dynamic nomogram for recurrent laryngeal nerve lymph node metastasis in esophageal squamous cell carcinoma. Front Surg 2022; 9:898705. [PMID: 36081588 PMCID: PMC9445191 DOI: 10.3389/fsurg.2022.898705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Accepted: 07/13/2022] [Indexed: 11/18/2022] Open
Abstract
Background Patients with esophageal squamous cell carcinoma (ESCC) are liable to develop recurrent laryngeal nerve (RLN) lymph node metastasis (LNM). We aimed to assess the predictive value of the long diameter (LD) and short diameter (SD) of RLN lymph node (LN) and construct a web-based dynamic nomogram for RLN LNM prediction. Methods We reviewed 186 ESCC patients who underwent RLN LN dissection from January 2016 to December 2018 in the Affiliated Hospital of North Sichuan Medical College. Risk factors for left and right RLN LNM were determined by univariate and multivariate analyses. A web-based dynamic nomogram was constructed by using logistic regression. The performance was assessed by the area under the curve (AUC) and Brier score. Models were internally validated by performing five-fold cross-validation. Results Patients who underwent left and right RLN LN dissection were categorized as left cohort (n = 132) and right cohort (n = 159), with RLN LNM rates of 15.9% (21/132) and 21.4% (34/159), respectively. The AUCs of the LD (SD) of RLN LN were 0.663 (0.688) in the left cohort and 0.696 (0.705) in the right cohort. The multivariate analysis showed that age, the SD of RLN LN, and clinical T stage were significant risk factors for left RLN LNM (all P < 0.05), while tumor location, the SD of RLN LN, and clinical T stage were significant risk factors for right RLN LNM (all P < 0.05). The dynamic nomograms showed reliable performance after five-fold cross-validation [(left (right), mean AUC: 0.814, range: 0.614–0.891 (0.775, range: 0.084–0.126); mean Brier score: 0.103, range: 0.084–0.126 (0.145, range: 0.105–0.206)], available at https://mpthtw.shinyapps.io/leftnomo/ and https://mpthtw.shinyapps.io/rightnomo/. Conclusion The LD and SD of RLN LN are inadequate to predict RLN LNM accurately, but online dynamic nomograms by combined risk factors show better prediction performance and convenient clinical application.
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Affiliation(s)
- Ting-Ting Chen
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, China
- Department of Cardiothoracic Intensive Care Unit, Affiliated Hospital of North Sichuan Medical College, Nanchong, China
- College of Medical Imaging, North Sichuan Medical College, Nanchong, China
| | - Hao-Ji Yan
- College of Medical Imaging, North Sichuan Medical College, Nanchong, China
| | - Xi He
- Department of Radiological Sciences, Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki, Japan
| | - Si-Yi Fu
- College of Clinical Medicine, North Sichuan Medical College, Nanchong, China
| | - Sheng-Xuan Zhang
- College of Clinical Medicine, North Sichuan Medical College, Nanchong, China
| | - Wan Yang
- College of Clinical Medicine, North Sichuan Medical College, Nanchong, China
| | - Yu-Jie Zuo
- College of Clinical Medicine, North Sichuan Medical College, Nanchong, China
| | - Hong-Tao Tang
- College of Clinical Medicine, North Sichuan Medical College, Nanchong, China
| | - Jun-Jie Yang
- College of Clinical Medicine, North Sichuan Medical College, Nanchong, China
| | - Pei-Zhi Liu
- College of Clinical Medicine, North Sichuan Medical College, Nanchong, China
| | - Hong-Ying Wen
- Department of Cardiothoracic Intensive Care Unit, Affiliated Hospital of North Sichuan Medical College, Nanchong, China
- Correspondence: Dong Tian Hong-Ying Wen
| | - Dong Tian
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, China
- Department of Cardiothoracic Intensive Care Unit, Affiliated Hospital of North Sichuan Medical College, Nanchong, China
- Academician (Expert) Workstation, Affiliated Hospital of North Sichuan Medical College, Nanchong, China
- Correspondence: Dong Tian Hong-Ying Wen
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Wang H, Lin Z, Lin Y, Huang R, Qiu M, Peng X, He F, Huang L, Xiang Z, Lu W, Yan S, Liu S, Yang H, Zhang Z, Hu Z. Optimal Size Criterion for Malignant Lymph Nodes and a Novel Lymph Node Clinical Staging System for Unresectable Esophageal Squamous Cell Carcinoma: Evaluation by Multislice Spiral Computed Tomography. J Cancer 2021; 12:6454-6464. [PMID: 34659536 PMCID: PMC8489143 DOI: 10.7150/jca.61994] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2021] [Accepted: 08/18/2021] [Indexed: 11/05/2022] Open
Abstract
Objectives: The current Chinese draft nodal clinical staging system for unresectable esophageal cancer is controversial. Our study aimed to propose a new diagnostic criterion for lymph node metastasis (LNM) detected by multislice spiral computed tomography (MSCT) in nonsurgically treated esophageal squamous cell carcinoma (ESCC) patients and then develop a novel lymph node (LN) clinical staging system for better individual prognostic prediction. Methods: The short-axis diameters of regional LNs were measured in 393 nonsurgical patients. Regional nodes were considered positive for malignancy if the nodal size exceeded the optimal size, which was determined by Kaplan-Meier survival analysis. The novel LN clinical staging system was then constructed using the LASSO model based on the relative prognostic importance of different LN stations. Validation cohort was included to confirm the prognostic performance. Results: Regional nodes were considered positive for malignancy if they were larger than 10 mm in the low cervical and upper thoracic segments, 7 mm in the middle thoracic segment, and 8 mm in the lower thoracic and celiac segments. Using the LASSO model, stations 2R, 3A, 7 and 16 were qualified in the model. Further analysis showed that our LN clinical staging system had better homogeneity, discriminatory ability and clinical value than the draft nodal staging system. Conclusions: Our results show that the new diagnostic criterion may improve the diagnostic value of MSCT in metastatic LNs. The novel LN clinical staging system can stratify nonsurgically treated ESCC patients into different risk groups, providing valuable information for decision making and outcome prediction.
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Affiliation(s)
- Hang Wang
- Department of Epidemiology and Health Statistics, Fujian Provincial Key Laboratory of Environment factors and Cancer, School of Public Health, Fujian Medical University, Fuzhou, 350108, China.,Department of Disease Prevention and Healthcare, Fujian Provincial Hospital South Branch & Fujian Provincial Jinshan Hospital, Fuzhou, 350001, China
| | - Zheng Lin
- Department of Epidemiology and Health Statistics, Fujian Provincial Key Laboratory of Environment factors and Cancer, School of Public Health, Fujian Medical University, Fuzhou, 350108, China.,Key Laboratory of Ministry of Education for Gastrointestinal Cancer, Fujian Medical University, Fuzhou, 350108, China.,Fujian Digital Institute of Tumor Big Data, Fujian Medical University, Fuzhou, 350122, China
| | - Yimin Lin
- Department of Epidemiology and Health Statistics, Fujian Provincial Key Laboratory of Environment factors and Cancer, School of Public Health, Fujian Medical University, Fuzhou, 350108, China.,Fujian Center for ADR monitoring, Fujian Food and Drug Administration, Fuzhou, 350003, China
| | - Ruigang Huang
- Department of Imaging, Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou, 363000, China
| | - Moliang Qiu
- Department of Imaging, Affiliated Fuzhou First Hospital of Fujian Medical University, Fuzhou, 350009, China
| | - Xiane Peng
- Department of Epidemiology and Health Statistics, Fujian Provincial Key Laboratory of Environment factors and Cancer, School of Public Health, Fujian Medical University, Fuzhou, 350108, China.,Key Laboratory of Ministry of Education for Gastrointestinal Cancer, Fujian Medical University, Fuzhou, 350108, China.,Fujian Digital Institute of Tumor Big Data, Fujian Medical University, Fuzhou, 350122, China
| | - Fei He
- Department of Epidemiology and Health Statistics, Fujian Provincial Key Laboratory of Environment factors and Cancer, School of Public Health, Fujian Medical University, Fuzhou, 350108, China.,Key Laboratory of Ministry of Education for Gastrointestinal Cancer, Fujian Medical University, Fuzhou, 350108, China.,Fujian Digital Institute of Tumor Big Data, Fujian Medical University, Fuzhou, 350122, China
| | - Liping Huang
- Department of Epidemiology and Health Statistics, Fujian Provincial Key Laboratory of Environment factors and Cancer, School of Public Health, Fujian Medical University, Fuzhou, 350108, China
| | - Zhisheng Xiang
- Department of Epidemiology and Health Statistics, Fujian Provincial Key Laboratory of Environment factors and Cancer, School of Public Health, Fujian Medical University, Fuzhou, 350108, China
| | - Wanting Lu
- Department of Epidemiology and Health Statistics, Fujian Provincial Key Laboratory of Environment factors and Cancer, School of Public Health, Fujian Medical University, Fuzhou, 350108, China
| | - Siyou Yan
- Department of Epidemiology and Health Statistics, Fujian Provincial Key Laboratory of Environment factors and Cancer, School of Public Health, Fujian Medical University, Fuzhou, 350108, China
| | - Shuang Liu
- Department of Epidemiology and Health Statistics, Fujian Provincial Key Laboratory of Environment factors and Cancer, School of Public Health, Fujian Medical University, Fuzhou, 350108, China
| | - Huimin Yang
- Department of Epidemiology and Health Statistics, Fujian Provincial Key Laboratory of Environment factors and Cancer, School of Public Health, Fujian Medical University, Fuzhou, 350108, China
| | - Zhihui Zhang
- Department of Epidemiology and Health Statistics, Fujian Provincial Key Laboratory of Environment factors and Cancer, School of Public Health, Fujian Medical University, Fuzhou, 350108, China
| | - Zhijian Hu
- Department of Epidemiology and Health Statistics, Fujian Provincial Key Laboratory of Environment factors and Cancer, School of Public Health, Fujian Medical University, Fuzhou, 350108, China.,Key Laboratory of Ministry of Education for Gastrointestinal Cancer, Fujian Medical University, Fuzhou, 350108, China.,Fujian Digital Institute of Tumor Big Data, Fujian Medical University, Fuzhou, 350122, China
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Zhao F, Lu RX, Liu JY, Fan J, Lin HR, Yang XY, You SH, Wu QG, Qin XY, Liu Y, Zhen FX, Luo JH, Wang W. Development and validation of nomograms to intraoperatively predict metastatic patterns in regional lymph nodes in patients diagnosed with esophageal cancer. BMC Cancer 2021; 21:22. [PMID: 33402129 PMCID: PMC7786479 DOI: 10.1186/s12885-020-07738-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2020] [Accepted: 12/15/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND An accurate intraoperative prediction of lymph node metastatic risk can help surgeons in choosing precise surgical procedures. We aimed to develop and validate nomograms to intraoperatively predict patterns of regional lymph node (LN) metastasis in patients with esophageal cancer. METHODS The prediction model was developed in a training cohort consisting of 487 patients diagnosed with esophageal cancer who underwent esophagectomy with complete LN dissection from January 2016 to December 2016. Univariate and multivariable logistic regression were used to identify independent risk factors that were incorporated into a prediction model and used to construct a nomogram. Contrast-enhanced computed tomography reported LN status and was an important comparative factor of clinical usefulness in a validation cohort. Nomogram performance was assessed in terms of calibration, discrimination, and clinical usefulness. An independent validation cohort comprised 206 consecutive patients from January 2017 to December 2017. RESULTS Univariate analysis and multivariable logistic regression revealed three independent predictors of metastatic regional LNs, three independent predictors of continuous regional LNs, and two independent predictors of skipping regional LNs. Independent predictors were used to build three individualized prediction nomograms. The models showed good calibration and discrimination, with area under the curve (AUC) values of 0.737, 0.738, and 0.707. Application of the nomogram in the validation cohort yielded good calibration and discrimination, with AUC values of 0.728, 0.668, and 0.657. Decision curve analysis demonstrated that the three nomograms were clinically useful in the validation cohort. CONCLUSION This study presents three nomograms that incorporate clinicopathologic factors, which can be used to facilitate the intraoperative prediction of metastatic regional LN patterns in patients with esophageal cancer.
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Affiliation(s)
- Fei Zhao
- Department of Thoracic Surgery, First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, China
| | - Rong-Xin Lu
- Department of Thoracic Surgery, First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, China
| | - Jin-Yuan Liu
- Department of Thoracic Surgery, First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, China
| | - Jun Fan
- Department of Thoracic Surgery, First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, China
| | - Hao-Ran Lin
- Department of Thoracic Surgery, First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, China
| | - Xiao-Yu Yang
- Department of Thoracic Surgery, First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, China
| | - Shu-Hui You
- Department of Thoracic Surgery, First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, China
| | - Qian-Ge Wu
- Department of Thoracic Surgery, First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, China
| | - Xue-Yun Qin
- Department of Thoracic Surgery, First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, China
| | - Yi Liu
- Department of Thoracic Surgery, First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, China
| | - Fu-Xi Zhen
- Department of Thoracic Surgery, First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, China.
| | - Jin-Hua Luo
- Department of Thoracic Surgery, First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, China.
| | - Wei Wang
- Department of Thoracic Surgery, First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, China.
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4
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Zheng Y, Li Y, Liu X, Zhang R, Sun H, Xing W. Right Compared With Left Thoracic Approach Esophagectomy for Patients With Middle Esophageal Squamous Cell Carcinoma. Front Oncol 2020; 10:536842. [PMID: 33194596 PMCID: PMC7649421 DOI: 10.3389/fonc.2020.536842] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Accepted: 08/18/2020] [Indexed: 11/17/2022] Open
Abstract
Background: In China, open surgical approaches for esophageal cancer (EC) can be divided into two techniques, the right- and left- transthoracic esophagectomy. Although there is an increasing number of instances that use the right side, the optimal surgical technique remains unclear. Based in a large cancer center with rich experience of both transthoracic side approaches, this study compared the long-term survival of patients treated by these two surgical techniques. Methods: The patients included in this study underwent a right transthoracic esophagectomy (Right, McKeown) or left transthoracic esophagectomy (Left, Sweet, or chest neck dual-incision) for esophageal squamous cell carcinoma (ESCC) between January 2015 and October 2018. The overall survival(OS) rate and perioperative data between the two groups were then retrospectively analyzed. Results: We included 437 patients who underwent Right (n = 202) and Left (n = 235) approaches for ESCC. There was a significantly longer median operative time (250 vs. 190 min, P < 0.001) and longer median postoperative hospital stay (17 vs. 14 days, P < 0.001) in the Right side group. The OS at 5-years was 49.9% in the Right group and 52.45% in the Left group; hazard ratio (HR) (95% CI): 1.002 (0.752–1.337), p = 0.987. Conclusions: For middle thoracic ESCC without suspected lymph node metastasis in the upper mediastinum, the esophagectomy through the Left thoracic approach could achieve the same OS as the Right side, with better short-term outcomes.
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Affiliation(s)
- Yan Zheng
- Department of Thoracic Surgery, The Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, Zhengzhou, China
| | - Yin Li
- Department of Thoracic Surgery, The Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, Zhengzhou, China.,Department of Thoracic Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xianben Liu
- Department of Thoracic Surgery, The Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, Zhengzhou, China
| | - Ruixiang Zhang
- Department of Thoracic Surgery, The Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, Zhengzhou, China
| | - Haibo Sun
- Department of Thoracic Surgery, The Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, Zhengzhou, China
| | - Wenqun Xing
- Department of Thoracic Surgery, The Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, Zhengzhou, China
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5
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Yang J, Liu Y, Li B, Jiang P, Wang C. Prognostic significance of tumor length in patients with esophageal cancer undergoing radical resection: A PRISMA-compliant meta-analysis. Medicine (Baltimore) 2019; 98:e15029. [PMID: 30946339 PMCID: PMC6456106 DOI: 10.1097/md.0000000000015029] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The prognostic significance of tumor length in esophageal cancer (EC) remains controversial. Hence, we conducted a meta-analysis to quantitatively assess the prognostic significance of tumor length in EC patients. METHOD A systematic literature search was conducted in the PubMed, EMBASE, and Web of Science. Hazard ratios (HRs) with their 95% confidence intervals (CIs) were used to assess the prognostic significance of tumor length for overall survival (OS), and disease-free survival (DFS) in EC patients. RESULTS A total of 21 articles with 22 eligible studies involving 9271 patients were included in this meta-analysis. The results of our pooling analyses demonstrated that tumor length was an independent prognostic parameter for OS (HR = 1.38, 95% CI: 1.24-1.54, P < .01) and DFS (HR = 1.29, 95% CI: 1.11-1.50, P < .01) in EC patients. Moreover, our subgroup analysis and sensitivity analysis showed that the pooled HRs assessing the prognostic significance of tumor length did not significantly fluctuated, suggesting our pooling analyses were stable and reliable. CONCLUSION The results of this meta-analysis demonstrated that long tumor is an independent risk of poor OS and DFS in EC patients, suggesting that it may provide additional prognostic information and thus contribute to a better stratification of EC patients, especially for those with no lymph node metastasis. However, more well-designed prospective clinical studies with large sample size are needed to strength our conclusion due to several limitations in this meta-analysis.
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Affiliation(s)
| | - Yahong Liu
- Department pediatrics, Lanzhou University Second Hospital, Lanzhou University Second Clinical Medical College, Lanzhou University, Lanzhou, China
| | - Bin Li
- Department of Thoracic Surgery
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Soeno T, Harada H, Hosoda K, Mieno H, Ema A, Ushiku H, Washio M, Kosaka Y, Watanabe M, Yamashita K. Lymph Node Progression and Optimized Node Dissection of Middle Thoracic Esophageal Squamous Cell Carcinoma in the Latest Therapeutic Surgical Strategy. Ann Surg Oncol 2019; 26:996-1004. [DOI: 10.1245/s10434-019-07190-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2018] [Indexed: 12/12/2022]
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7
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Wang WP, Ni PZ, Yang YS, He SL, Hu WP, Chen LQ. The Role and Prognostic Significance of Aortopulmonary, Anterior Mediastinal, and Tracheobronchial Lymph Nodes in Esophageal Cancer: Update of the Eighth-Edition TNM Staging System (2018). Ann Surg Oncol 2018; 26:1005-1011. [PMID: 30511093 DOI: 10.1245/s10434-018-07086-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2017] [Indexed: 02/05/2023]
Abstract
BACKGROUND The eighth edition of TNM staging for esophageal cancer will be implemented at 2018. The stations 5, 6, and 10 lymph nodes (LNs) have been omitted from the regional lymph node map for the new TNM staging. However, the role and prognostic significance of these LN stations were not clear. The purpose of this study was to investigate whether the revised nodal staging is appropriate and to verify the role, prognostic significance, and therapeutic value of these LNs in esophageal cancer. METHODS The records of patients who underwent esophagectomy for cancer in our department between 2007 and 2013 were retrospectively analyzed. The rate of metastases was calculated for stations 5, 6, and 10 LNs. LN metastasis and patient survival were analyzed. RESULTS A total of 1637 patients were included. The calculated rate of metastasis to stations 5, 6, and 10 was 3.2%, 2.3%, and 4.9%, respectively. No difference was found in the N stage determined by the seventh and eighth edition N staging systems. The status of station 5, 6, or 10 was not associated with long-term survival according to Cox proportional hazards model analysis. CONCLUSIONS Metastasis to stations 5, 6, or 10 LNs was infrequent. Omitting of stations 5, 6, and 10 LNs in the eighth edition TNM staging did not influence the accuracy and survival-predicting efficacy. The therapeutic value of lymphadenectomy of stations 5, 6, and 10 was limited. The status of stations 5, 6, and 10 LNs was not associated with long-term survival.
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Affiliation(s)
- Wen-Ping Wang
- Department of Thoracic Surgery, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Peng-Zhi Ni
- Department of Thoracic Surgery, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Yu-Shang Yang
- Department of Thoracic Surgery, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Song-Lin He
- 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
| | - Long-Qi Chen
- Department of Thoracic Surgery, West China Hospital of Sichuan University, Chengdu, Sichuan, China.
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8
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Lin Z, Chen W, Chen Y, Peng X, Zhu K, Lin Y, Lin Q, Hu Z. A new classification of lymph node metastases according to the lymph node stations for predicting prognosis in surgical patients with esophageal squamous cell carcinoma. Oncotarget 2018; 7:76261-76273. [PMID: 27788489 PMCID: PMC5342812 DOI: 10.18632/oncotarget.12842] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2016] [Accepted: 10/12/2016] [Indexed: 01/02/2023] Open
Abstract
Lymph node metastasis (LNM) is one of the major prognostic factors for esophageal squamous cell carcinoma (ESCC). However there is no consensus regarding the prognostic significance of the location of LNM. Therefore, a novel classification was proposed to identify the lymph node (LN) stations which may be useful in predicting prognosis. A total of 260 ESCC patients were enrolled in this prospective study. The prognostic values of LNM in different lymph node (LN) stations were evaluated by random survival forests (RSF). Their prognostic significance was examined by Cox regression and receiver operating characteristic curve (ROC). The three most frequently involved LN stations were station 16 (24.49%), station 1 (22.22%) and station 2 (21.05%). Stations 1, 2, 8M, 8L and 16 were grouped as dominant LN stations (DLNS) which showed higher values in predicting overall survival (OS) and disease-free survival (DFS) than the remaining LN stations, which we define as non-dominant LN stations (N-DLNS). LNM features of DLNS (number of positive LN stations, number of positive LNs and LN ratio), but not those from N-DLNS, served as independent prognostic factors (P<0.05) whenever used alone or when combined with factors from N-DLNS. Furthermore, the area under ROC indicated that DLNS is a more accurate prediction than N-DLNS (P<0.05). This study demonstrated the value of LNM in DLNS in predicting prognosis in surgical ESCC patients, which outperformed those from N-DLNS. Therefore, the method of dominant and non-dominant classification may serve as an additional parameter to improve individualized therapeutic strategies.
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Affiliation(s)
- Zheng Lin
- Department of Epidemiology and Health Statistics, Fujian Provincial Key Laboratory of Environment Factors and Cancer, School of Public Health, Fujian Medical University, Fuzhou 350108, China
| | - Weilin Chen
- Department of Radiation Oncology, Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou 363000, China
| | - Yuanmei Chen
- Department of Thoracic Surgery, Fujian Provincial Cancer Hospital Affiliated to Fujian Medical University, Fuzhou 350014, China
| | - Xiane Peng
- Department of Epidemiology and Health Statistics, Fujian Provincial Key Laboratory of Environment Factors and Cancer, School of Public Health, Fujian Medical University, Fuzhou 350108, China.,Key Laboratory of Ministry of Education for Gastrointestinal Cancer, Fujian Medical University, Minhou, Fuzhou 350108, China
| | - Kunshou Zhu
- Department of Thoracic Surgery, Fujian Provincial Cancer Hospital Affiliated to Fujian Medical University, Fuzhou 350014, China
| | - Yimin Lin
- Department of Epidemiology and Health Statistics, Fujian Provincial Key Laboratory of Environment Factors and Cancer, School of Public Health, Fujian Medical University, Fuzhou 350108, China
| | - Qiaokuang Lin
- Department of Radiation Oncology, Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou 363000, China
| | - Zhijian Hu
- Department of Epidemiology and Health Statistics, Fujian Provincial Key Laboratory of Environment Factors and Cancer, School of Public Health, Fujian Medical University, Fuzhou 350108, China.,Key Laboratory of Ministry of Education for Gastrointestinal Cancer, Fujian Medical University, Minhou, Fuzhou 350108, China
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9
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Lv W, Zeng G, Wu W, Wei W, Li X, Yang W. Application of single-port video-assisted thoracoscope in treating thoracic oesophageal squamous cell carcinoma using McKeown approach. J Minim Access Surg 2017; 14:105-110. [PMID: 28782745 PMCID: PMC5869968 DOI: 10.4103/jmas.jmas_36_17] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
Objective: This study aims to investigate the feasibility of single-port video-assisted thoracoscope (SPVATS) in treating thoracic oesophageal squamous cell carcinoma (TESCC) using McKeown approach. Materials and Methods: Totally 10 McKeown approach-based SPVATS surgeries (8 males and 2 females, aged 42–68 years) were carried out from January 2015 to December 2015 to treat TESCC, including one case in upper thoracic segment, 5 cases in median thoracic segment and 4 cases in inferior thoracic segment. All the cases were pathologically diagnosed as SCC pre-operatively. SPVATS was performed to free thoracic oesophagus and dissect the lymph nodes, and laparoscopy was performed to free stomach and to perform oesophagus-left gastric collum anastomosis. Results: All the patients were successfully completed SPVATS, with average thoracic surgery time as 150 min, intra-operative blood loss as 30–260 ml (average 90 ml), and post-operative hospital stay as 9–16 days (average 12 days). Conclusions: SPVATS was technically feasible and safe in treating TESCC using McKeown approach, with less trauma and rapid post-operative recovery, and hence, it could be used as a new surgical option for McKeown approach-based TESCC treatment.
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Affiliation(s)
- Wenqiang Lv
- Department of Thoracic and Cardiovascular Surgery, People's Hospital of Jieyang, Jieyang 522000, People's Republic of China
| | - Guiqing Zeng
- Department of Thoracic and Cardiovascular Surgery, People's Hospital of Jieyang, Jieyang 522000, People's Republic of China
| | - Weibin Wu
- Department of Thoracic and Cardiovascular Surgery, People's Hospital of Jieyang, Jieyang 522000, People's Republic of China
| | - Wuzhi Wei
- Department of Thoracic and Cardiovascular Surgery, People's Hospital of Jieyang, Jieyang 522000, People's Republic of China
| | - Xiaodong Li
- Department of Thoracic Surgery, Sun Yat-sen University Cancer Center, Guangzhou 510060, Guangdong Province, People's Republic of China
| | - Wenke Yang
- Department of Anesthesiology, People's Hospital of Jieyang, Jieyang 522000, People's Republic of China
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10
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Lv WQ, Wei WZ, Wu WB, Zeng GQ, Huang RX, Zhang LS. Significance of Upper Mediastinal Lymph Node Dissection with Video-Assisted Thoracic Surgery in the Treatment of Middle Thoracic Esophageal Carcinoma. J Laparoendosc Adv Surg Tech A 2017; 27:1061-1064. [PMID: 28574749 DOI: 10.1089/lap.2016.0625] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND The aim of this study was to explore the significance of upper mediastinal lymph node dissection performed by video-assisted thoracic surgery in the treatment of middle thoracic esophageal carcinoma. MATERIALS AND METHODS The clinical and pathological data from 128 patients with middle thoracic esophageal carcinoma who underwent surgery from January 2013 to December 2015 using a right chest-abdomen-neck approach combined with thoracoscopy and laparoscopy in the Jieyang People's Hospital of Huangdong province were analyzed retrospectively. RESULTS The lymph node metastasis rates of the thoracic left para-recurrent laryngeal nerve (1, 2, and 4L zones) and right para-recurrent laryngeal nerve (1R zone) were 30.47% and 28.12% in 128 cases, respectively. The metastasis rates of the 2R, 4R, and 5 zones were 4.69%, 3.91%, and 5.47%, respectively. CONCLUSIONS The upper mediastinal region was the most common location for lymph node metastasis from middle thoracic esophageal carcinoma, and upper mediastinal lymph node dissection performed by video-assisted thoracic surgery was safe and complete. It also reduced the risk of para-recurrent laryngeal nerve injury, residual tumor, and the postoperative recurrence rate.
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Affiliation(s)
- Wen-Qiang Lv
- 1 Department of Thoracic and Cardiovascular Surgery, People's Hospital of Jieyang , Jieyang, China
| | - Wu-Zhi Wei
- 1 Department of Thoracic and Cardiovascular Surgery, People's Hospital of Jieyang , Jieyang, China
| | - Wei-Bin Wu
- 1 Department of Thoracic and Cardiovascular Surgery, People's Hospital of Jieyang , Jieyang, China
| | - Gui-Qing Zeng
- 1 Department of Thoracic and Cardiovascular Surgery, People's Hospital of Jieyang , Jieyang, China
| | - Rui-Xin Huang
- 2 Department of Anesthesiology, People's Hospital of Jieyang , Jieyang, China
| | - Long-Sheng Zhang
- 2 Department of Anesthesiology, People's Hospital of Jieyang , Jieyang, China
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Wang ZQ, Deng HY, Hu Y, Yuan Y, Wang WP, Wang YC, Chen LQ. Prognostic value of right upper mediastinal lymphadenectomy in Sweet procedure for esophageal cancer. J Thorac Dis 2016; 8:3625-3632. [PMID: 28149557 DOI: 10.21037/jtd.2016.12.50] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND The prognostic value of the right upper mediastinal lymph node dissection (RUMLND) for patients with middle or lower thoracic esophageal squamous cell carcinoma (ESCC-MLT) is still not well established yet. Our objective is to evaluate the prognostic role of the Sweet procedure plus right upper mediastinal lymph node dissection (MS) by comparing with the Sweet procedure with standard lymph node dissection (SS) in terms of long-term survival. METHODS Totally 1,477 ESCC-MLT patients underwent radical intent surgery (186 with MS, 1,291 with SS) at our department between January 2007 and September 2013. After propensity score matching (PSM), 186 patients from each group were matched and analyzed. The 5-year survival rates in two groups were compared by detailed stratifications in terms of clinical characteristics. RESULTS As for the prognostic role of RUMLND, patients treated with MS tended to obtain higher 5-year survival rate than patients treated with SS in univariate analysis (48.1% vs. 37.4%). Moreover, in multivariate analysis, MS yielded significant higher 5-year survival rate compared with SS (P=0.041). In addition, subgroup analyses of the survival between the MS and SS patients by detailed stratifications demonstrated the survival superiority in the MS group with age <60 years old, TNM stage III, number of lymph node dissection (LND) ≥15, as well as no using of postoperative adjuvant treatment. CONCLUSIONS The RUMLND in Sweet procedure is an independent prognostic factor for ESCC-MLT patients, especially for those with thoracic middle segment-located tumor, stage III or younger.
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Affiliation(s)
- Zhi-Qiang Wang
- Department of Thoracic Surgery, West China Hospital of Sichuan University, Chengdu 610041, China;; Department of Thoracic Surgery, Chongqing Cancer Institute, Chongqing 400030, China
| | - Han-Yu Deng
- Department of Thoracic Surgery, West China Hospital of Sichuan University, Chengdu 610041, China
| | - Yang Hu
- Department of Thoracic Surgery, West China Hospital of Sichuan University, Chengdu 610041, China
| | - Yong Yuan
- Department of Thoracic Surgery, West China Hospital of Sichuan University, Chengdu 610041, China
| | - Wen-Ping Wang
- Department of Thoracic Surgery, West China Hospital of Sichuan University, Chengdu 610041, China
| | - Yun-Cang Wang
- 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
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Wang ZQ, Wang WP, Yuan Y, Hu Y, Peng J, Wang YC, Chen LQ. Left thoracotomy for middle or lower thoracic esophageal carcinoma: still Sweet enough? J Thorac Dis 2016; 8:3187-3196. [PMID: 28066598 DOI: 10.21037/jtd.2016.11.62] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND Esophagectomy via left thoracotomy (the Sweet procedure) has long been the conventional route for resection of esophageal carcinoma, especially in China. However, this procedure is being increasingly critiqued, mainly regarding the lymphadenectomy. The objective of this study was to compare the Sweet procedure with the right upper mediastinal lymph node resection (MS) and Ivor-Lewis (IL) procedure in the treatment of middle or lower thoracic esophageal squamous cell carcinoma (OSCC-MLT) in terms of lymphadenectomy, postoperative complications, and long-term survival. METHODS A total of 336 OSCC-MLT patients underwent radical intent surgery (188 with MS and 148 with IL procedure) between January 2007 and September 2013 in our hospital. After propensity score matching, 129 patients from each procedure were included. The efficacy of lymph node dissection at each station was estimated by the index of estimated benefit from lymph node dissection (IEBLD). RESULTS IEBLD is relatively high in stations 2L, 2R, 8, 16 and 17. The metastasis rates and ratios were similar between the MS and IL procedures at each station. The MS procedure significantly outperformed the IL procedure with a shorter operating time (212 vs. 317 min), shorter in-hospital stay (10.7 vs. 15.3 days), and fewer postoperative complications (30.2% vs. 43.4%). However, the 5-year survival rates were not significantly different between the two procedures (46.9% vs. 44.0%). CONCLUSIONS The MS procedure of esophagectomy is not inferior to the IL procedure in efficiency, moreover the MS procedure is safer.
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Affiliation(s)
- Zhi-Qiang Wang
- Department of Thoracic Surgery, West China Hospital of Sichuan University, Chengdu 610041, China; Department of Thoracic Surgery, Chongqing Cancer Institute, Chongqing 400030, China
| | - Wen-Ping Wang
- Department of Thoracic Surgery, West China Hospital of Sichuan University, Chengdu 610041, China
| | - Yong Yuan
- Department of Thoracic Surgery, West China Hospital of Sichuan University, Chengdu 610041, China
| | - Yang Hu
- Department of Thoracic Surgery, West China Hospital of Sichuan University, Chengdu 610041, China
| | - Jun Peng
- Department of Thoracic Surgery, West China Hospital of Sichuan University, Chengdu 610041, China
| | - Yun-Cang Wang
- 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
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Zhang J, Heng X, Luo Y, Fu Q, Li Z, Che F, Li B. Influence of negative lymph node in No 7 on survival of patients with middle thoracic esophageal squamous cell carcinoma. Onco Targets Ther 2016; 9:1831-7. [PMID: 27099516 PMCID: PMC4821374 DOI: 10.2147/ott.s94236] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Background The overall survival (OS) of patients with thoracic esophageal cancer is poor because of the high rate of lymph node metastases. However, recent studies found that the negative lymph node (LN) may also influence the patients’ OS. The purpose of this study is to investigate which negative LN stations play a key role in OS prediction. Method Our study included the retrospective records of 99 patients, who were identified with middle thoracic esophageal squamous cell cancer after esophagectomy. The maximum follow-up time was 6 years. Cox regression models were employed to determine the association between the negative LN and OS of patients. After applying Kaplan–Meier method to calculate OS of patients with positive and negative LNs, the log-rank tests were used to assess the difference between them. Result The hazard ratio of the total number of negative LNs was 0.937 (P=0.001), and the length of tumor was 1.166 (P=0.038). Multivariate regression results showed that the numbers of positive LNs in No 3 and 7 stations and negative LNs in No 109 and 7 stations were significantly related to OS, and their P-values were 0.017, 0.001, 0.020, and 0.022, respectively. The OS of the patients who had positive and negative LNs in No 7 station was significantly different (P=0.028). Conclusion No 7 is the most important among the negative LN stations which prolong OS. More attention should be paid to this area when making treatment plan for patients with no negative LNs identified in operation.
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Affiliation(s)
- Jinling Zhang
- Cancer Center, LinYi People Hospital, Affiliated to Shandong University, School of Medicine, Jinan, Shandong Province, People's Republic of China
| | - Xueyuan Heng
- Cancer Center, LinYi People Hospital, Affiliated to Shandong University, School of Medicine, Jinan, Shandong Province, People's Republic of China
| | - Yi Luo
- Department of Radiation Oncology, University of Michigan, Ann Arbor, MI, USA
| | - Qingxi Fu
- Cancer Center, LinYi People Hospital, Affiliated to Shandong University, School of Medicine, Jinan, Shandong Province, People's Republic of China
| | - Zhengrong Li
- Cancer Center, LinYi People Hospital, Affiliated to Shandong University, School of Medicine, Jinan, Shandong Province, People's Republic of China
| | - Fengyuan Che
- Cancer Center, LinYi People Hospital, Affiliated to Shandong University, School of Medicine, Jinan, Shandong Province, People's Republic of China
| | - Baosheng Li
- Department of Radiation Oncology (Chest Section), Shandong's Key Laboratory of Radiation Oncology, Shandong Cancer Hospital, Shandong Academy of Medical Sciences, Jinan, Shandong Province, People's Republic of China
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Van De Voorde L, Larue RT, Pijls M, Buijsen J, Troost EG, Berbée M, Sosef M, van Elmpt W, Schraepen MC, Vanneste B, Oellers M, Lambin P. A qualitative synthesis of the evidence behind elective lymph node irradiation in oesophageal cancer. Radiother Oncol 2014; 113:166-74. [DOI: 10.1016/j.radonc.2014.11.010] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2014] [Revised: 10/10/2014] [Accepted: 11/09/2014] [Indexed: 12/21/2022]
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