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Abstract
OBJECTIVE To examine the hypothesis that survival in esophageal cancer increases with more removed lymph nodes during esophagectomy up to a plateau, after which it levels out or even decreases with further lymphadenec-tomy. SUMMARY OF BACKGROUND DATA There is uncertainty regarding the ideal extent of lymphadenectomy during esophagectomy to optimize long-term survival in esophageal cancer. METHODS This population-based cohort study included almost every patient who underwent esophagectomy for esophageal cancer in Sweden or Finland in 2000-2016 with follow-up through 2019. Degree of lymphadenectomy, divided into deciles, was analyzed in relation to all-cause 5-year mortality. Multivariable Cox regression provided hazard ratios (HR) with 95% confidence intervals (95% CI) adjusted for all established prognostic factors. RESULTS Among 2306 patients, the second (4-8 nodes), seventh (21-24 nodes) and eighth decile (25-30 nodes) of lymphadenectomy showed the lowest all-cause 5-year mortality compared to the first decile [hazard ratio (HR) = 0.77, 95% CI 0.61-0.97, HR = 0.76, 95% CI 0.59-0.99, and HR = 0.73, 95% CI 0.57-0.93, respectively]. In stratified analyses, the survival benefit was greatest in decile 7 for patients with pathological T-stage T3/T4 (HR = 0.56, 95% CI0.40-0.78), although it was statistically improved in all deciles except decile 10. For patients without neoadjuvant chemotherapy, survival was greatest in decile 7 (HR = 0.60, 95% CI 0.41-0.86), although survival was also statistically significantly improved in deciles 2, 6, and 8. CONCLUSION Survival in esophageal cancer was not improved by extensive lymphadenectomy, but resection of a moderate number (20-30) of nodes was prognostically beneficial for patients with advanced T-stages (T3/T4) and those not receiving neoadjuvant therapy.
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Zheng J, Yan Q, Hu W, Luo B, Li Y. Minimum number of necessary lymph nodes for the accurate staging of adenocarcinoma of esophagogastric junction. Asian J Surg 2023; 46:1215-1219. [PMID: 36031514 DOI: 10.1016/j.asjsur.2022.08.034] [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: 05/30/2022] [Revised: 08/09/2022] [Accepted: 08/12/2022] [Indexed: 11/02/2022] Open
Abstract
OBJECTIVE This study aims to explore the minimum number of lymph nodes (LNs) necessary for assessing the postoperative staging of adenocarcinoma of esophagogastric junction (AEG). METHODS We extracted the data of patients from the Surveillance Epidemiology and End Results (SEER) database, who were pathologically diagnosed with AEG between 2000 and 2017. We explored the associations between the number of LNs and overall survival (OS) by univariate and multivariate analyses and determined the proper cutoff value of the number of LNs necessary for accurate postoperative staging. RESULTS Of the patients with AEG in the SEER database, 2668 met our inclusion criteria. The total number of regional LNs dissected was found to be significantly associated with survival in analyses stratified by T stage. Univariate and multivariate regression showed that age, grade, positive LNs, number of LNs examined, and T stage were independently associated with OS. For patients with T1-2 tumors, the 5-year survival rate was 58.7%, and patients with more than 11 LNs examined obtained a greater survival benefit. Among patients with T3-4 tumors, the 5-year survival rates were 28.9% and 39.7% for those with 1-16 LNs examined and for those with more than 17 LNs examined, respectively. CONCLUSION To accurately determine the pathological stage of patients with AEG, no less than 11 LNs must be resected for patients with stage T1-2 disease, and no less than 16 LNs must be resected for patients with stage T3-4 disease.
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Affiliation(s)
- Jiabin Zheng
- Department of Gastrointestinal Surgery, Department of General Surgery, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510080, PR China.
| | - Qian Yan
- Department of Gastrointestinal Surgery, Department of General Surgery, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510080, PR China; South China University of Technology School of Medicine, Guangzhou, 511442, PR China.
| | - Weixian Hu
- Department of Gastrointestinal Surgery, Department of General Surgery, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510080, PR China.
| | - Bin Luo
- Department of Gastrointestinal Surgery, Department of General Surgery, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510080, PR China.
| | - Yong Li
- Department of Gastrointestinal Surgery, Department of General Surgery, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510080, PR China; South China University of Technology School of Medicine, Guangzhou, 511442, PR China; The Second School of Clinical Medicine, Southern Medical University, Guangzhou, 510080, PR China.
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Wang H, Yang Y, zhu K, Zhu N, Gong L, Zhang H, Ma M, Ren P, Qiao Y, Liu X, Tang P, Yu Z. Development and validation of nodal staging score in pN0 patients with esophageal squamous cell carcinoma: A population study from the SEER database and a single-institution cohort. Thorac Cancer 2022; 13:3257-3267. [PMID: 36221304 PMCID: PMC9715890 DOI: 10.1111/1759-7714.14670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Revised: 09/10/2022] [Accepted: 09/12/2022] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Patients with esophageal squamous cell carcinoma (ESCC) with lymph node metastasis may be misclassified as pN0 due to an insufficient number of lymph nodes examined (LNE). The purpose of this study was to confirm that patients with ESCC are indeed pN0 and to propose an adequate number for the correct nodal stage using the nodal staging score (NSS) developed by the beta-binomial model. METHODS A total of 1249 patients from the Surveillance, Epidemiology, and End Results (SEER) database between 2000 and 2017, and 1404 patients diagnosed with ESCC in our database between 2005 and 2018 were included. The NSS was developed to assess the probability of pN0 status based on both databases. The effectiveness of NSS was verified using survival analysis, including Kaplan-Meier curves and Cox models. RESULTS Many patients were misclassified as pN0 based on our algorithm due to insufficient LNE. As the number of LNE increased, false-negative findings dropped; accordingly, the NSS increased. In addition, NSS was an independent prognostic indicator for pN0 in patients with ESCC in the SEER database (hazard ratio [HR] 0.182, 95% confidence interval [CI] 0.046-0.730, p = 0.016) and our database (HR 0.215, 95% CI 0.055-0.842, p = 0.027). A certain number of nodes must be examined to achieve 90% of the NSS. CONCLUSIONS NSS could determine the probability of true pN0 status for patients, and it was sufficient in predicting survival and obtaining adequate numbers for lymphadenectomy.
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Affiliation(s)
- Haitong Wang
- Department of Esophageal Cancer, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and TherapyTianjin's Clinical Research Center for CancerTianjinChina
| | - Yueyang Yang
- Department of Esophageal Cancer, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and TherapyTianjin's Clinical Research Center for CancerTianjinChina
| | - Kai zhu
- Department of Esophageal Cancer, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and TherapyTianjin's Clinical Research Center for CancerTianjinChina
| | - Ningning Zhu
- Department of Esophageal Cancer, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and TherapyTianjin's Clinical Research Center for CancerTianjinChina
| | - Lei Gong
- Department of Esophageal Cancer, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and TherapyTianjin's Clinical Research Center for CancerTianjinChina
| | - Hongdian Zhang
- Department of Esophageal Cancer, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and TherapyTianjin's Clinical Research Center for CancerTianjinChina
| | - Mingquan Ma
- Department of Esophageal Cancer, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and TherapyTianjin's Clinical Research Center for CancerTianjinChina
| | - Peng Ren
- Department of Esophageal Cancer, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and TherapyTianjin's Clinical Research Center for CancerTianjinChina
| | - Yufeng Qiao
- Department of Esophageal Cancer, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and TherapyTianjin's Clinical Research Center for CancerTianjinChina
| | - Xiangming Liu
- Department of Esophageal Cancer, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and TherapyTianjin's Clinical Research Center for CancerTianjinChina
| | - Peng Tang
- Department of Esophageal Cancer, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and TherapyTianjin's Clinical Research Center for CancerTianjinChina
| | - Zhentao Yu
- Department of Esophageal Cancer, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and TherapyTianjin's Clinical Research Center for CancerTianjinChina,National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital & Shenzhen HospitalChinese Academy of Medical Sciences and Peking Union Medical CollegeShenzhenChina
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Tian D, Li HX, Yang YS, Yan HJ, Jiang KY, Zheng YB, Zong ZD, Zhang HL, Guo XG, Wen HY, Chen LQ. The minimum number of examined lymph nodes for accurate nodal staging and optimal survival of stage T1-2 esophageal squamous cell carcinoma: A retrospective multicenter cohort with SEER database validation. Int J Surg 2022; 104:106764. [PMID: 35803513 DOI: 10.1016/j.ijsu.2022.106764] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 06/14/2022] [Accepted: 06/26/2022] [Indexed: 02/05/2023]
Abstract
BACKGROUND The extent of lymphadenectomy during esophagectomy remains controversial for patients with T1-2 ESCC. The aim of this study was to identify the minimum number of examined lymph node (ELN) for accurate nodal staging and overall survival (OS) of patients with T1-2 esophageal squamous cell carcinoma (ESCC). MATERIALS AND METHODS Patients with T1-2 ESCC from three institutes between January 2011 and December 2020 were retrospectively reviewed. The associations of ELN count with nodal migration and OS were evaluated using multivariable models, and visualized by using locally weighted scatterplot smoothing (LOWESS). Chow test was used to determine the structural breakpoints of ELN count. External validation in the SEER database was performed. RESULTS In total, 1537 patients were included. Increased ELNs was associated with an increased likelihood of having positive nodal disease and incremental OS. The minimum numbers of ELNs for accurate nodal staging and optimal survival were 14 and 18 with validation in the SEER database (n = 519), respectively. The prognostic prediction ability of N stage was improved in the group with ≥14 ELNs compared with those with fewer ELNs (iAUC, 0.70 (95%CI 0.66-0.74) versus 0.61(95%CI 0.57-0.65)). The higher prognostic value was found for patients with ≥18 ELNs than those with <18 ELNs (iAUC, 0.78 (95%CI 0.74-0.82) versus 0.73 (95%CI 0.7-0.77)). CONCLUSION The minimum numbers of ELNs for accurate nodal staging and optimal survival of stage T1-2 ESCC patients were 14 and 18, respectively.
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Affiliation(s)
- Dong Tian
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, 610041, China; Department of Cardiothoracic Intensive Care Unit, Affiliated Hospital of North Sichuan Medical College, Nanchong, 637000, China; Academician (Expert) Workstation, Affiliated Hospital of North Sichuan Medical College, Nanchong 637000, China
| | - Hao-Xuan Li
- College of Stomatology, North Sichuan Medical College, Nanchong, China
| | - Yu-Shang Yang
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Hao-Ji Yan
- College of Medical Imaging, North Sichuan Medical College, Nanchong, 637000, China
| | - Kai-Yuan Jiang
- Department of Surgery, Tohoku University Graduate School of Medicine, Sendai 80-8575, Japan
| | - Yin-Bin Zheng
- Department of Thoracic Surgery, Nanchong Central Hospital, Nanchong, 637000, China
| | - Zheng-Dong Zong
- College of Clinical Medicine, North Sichuan Medical College, Nanchong, 637000, China
| | - Han-Lu Zhang
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Xiao-Guang Guo
- Department of Pathology, Nanchong Central Hospital, Nanchong, 637000, 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, Chengdu, 610041, China.
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Effect of the postural transition in minimally invasive esophagectomy: a propensity score matching analysis. Surg Endosc 2021; 36:3947-3956. [PMID: 34494153 DOI: 10.1007/s00464-021-08714-5] [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: 01/17/2021] [Accepted: 08/30/2021] [Indexed: 12/24/2022]
Abstract
BACKGROUND The advantages of prone position in minimally invasive esophagectomy have not been well studied. This study aimed to investigate the safety and feasibility of a transition from the left lateral decubitus position to the prone position for thoracic procedures in minimally invasive esophagectomy. METHODS We retrospectively analyzed patients with thoracic esophageal carcinomas who underwent thoracoscopic esophagectomy and laparoscopic gastric mobilization between January 2015 and December 2019. The left decubitus and prone positions were analyzed using propensity score-matched pairs for the baseline characteristics, morbidity, and survival. RESULTS A total of 114 consecutive patients were included in this study; 90 (78.9%) were male and the median age was 67.2 years old. Of these patients, 39 and 75 underwent left decubitus and prone esophagectomy, respectively. Prone esophagectomy was associated with a lower incidence of pneumonia than that performed in the decubitus position (12.5% vs. 37.5%, p = 0.0187). With respect to the long-term outcomes, there were no significant differences between the 2 groups. The 4-year overall and relapse-free survival rates for prone and decubitus esophagectomy were 73.8% and 73.2%, and 84.4% and 71.8%, respectively (p = 0.9899 and 0.6751, respectively). Prone esophagectomy yielded a shorter operative time (total: 528 [485-579] min vs. 581 [555-610] min, p < 0.0022; thoracic section: 243 [229-271] min vs. 292 [274-309] min, p < 0.0001), less bleeding in the thoracic procedures (0 [0-10] mL vs. 70 [20-138] mL, p < 0.0001), a shorter length of postoperative hospital stay (19 [15-23] vs. 30 [21-46] days, p = 0.0002), and a lower total hospital charge (30,046 [28,175-32,660] US dollars vs. 36,396 [31,533-41,180] US dollars, p < 0.0001). CONCLUSIONS Transition into the prone position in minimally invasive esophagectomy is feasible with adequate postoperative and oncological safety and economical in esophageal cancer surgery.
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Qi Z, Hu Y, Qiu R, Li J, Li Y, He M, Wang Y. Survival risk prediction model for patients with pT 1-3 N 0M 0 esophageal squamous cell carcinoma after R0 esophagectomy with two-field lymphadenectomy for therapeutic purposes. J Cardiothorac Surg 2021; 16:121. [PMID: 33933129 PMCID: PMC8088719 DOI: 10.1186/s13019-021-01503-0] [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: 10/28/2020] [Accepted: 04/19/2021] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND The overall survival (OS) remains unsatisfactory in patients with esophageal squamous cell carcinoma (ESCC) after extended esophagectomy with two-field lymphadenectomy. Therefore, this retrospective study aimed to identify the risk factors that contribute to the low survival of patients with pT1-3N0M0 ESCC. METHODS Patients with pT1-3N0M0 ESCC who only underwent R0 esophagectomy with two-field lymphadenectomy in our department from January 2008 to December 2012 were retrospectively enrolled in this study and medical records were reviewed. Postoperative OS, disease-free survival (DFS), recurrence-free survival (RFS), and locoregional recurrence-free survival (LRFS) were analyzed sequentially. RESULTS This study recruited a total of 488 patients, whose follow-up visits were completed at the end of December 2019. The five-year OS, DFS, RFS and LRFS rates were 62.1, 53.1, 58.3 and 65.6%, respectively. Multivariate Cox analysis identified patient age, site of the lesion, small mediastinal lymph nodes in CT imaging (SLNs in CT), dissected lymph nodes (LNs), and stage of esophageal malignancy as independent risk factors for OS of the patients. Of these factors, the site of the lesion, SLNs in CT and stage of the cancer were determined to be independent factors for DFS, RFS and LRFS. Based on all five factors, the recursive partitioning analysis (RPA) score system was developed to stratify the patients into low-, medium- and high-risk groups, which were found to possess significantly different rates of OS, DFS, RFS and LRFS (p < 0.001). CONCLUSIONS Several factors were associated with the survival of patients with pT1-3 N0M0 ESCC who underwent extended esophagectomy with two-field lymphadenectomy. These factors contributed to the RPA scoring system, which could stratify the risk of postoperative survival and may expedite the initiation of postoperative adjuvant therapy.
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Affiliation(s)
- Zhan Qi
- Department of thoracic surgery, Fourth Hospital of Hebei Medical University, Shijiazhuang, 050011, China
| | - Yuanping Hu
- Department of Radiation Oncology, Fourth Hospital of Hebei Medical University, No.12, Jiankang road, Shijiazhuang, 050011, China.,Hebei Clinical Research Center for Radiation Oncology, Shijiazhuang, China
| | - Rong Qiu
- Department of Radiation Oncology, Fourth Hospital of Hebei Medical University, No.12, Jiankang road, Shijiazhuang, 050011, China.,Hebei Clinical Research Center for Radiation Oncology, Shijiazhuang, China
| | - Juan Li
- Department of Radiation Oncology, Fourth Hospital of Hebei Medical University, No.12, Jiankang road, Shijiazhuang, 050011, China.,Hebei Clinical Research Center for Radiation Oncology, Shijiazhuang, China
| | - Yuekao Li
- Department of CT/MRI, Fourth Hospital of Hebei Medical University, Shijiazhuang, 050011, China
| | - Ming He
- Department of thoracic surgery, Fourth Hospital of Hebei Medical University, Shijiazhuang, 050011, China
| | - Yuxiang Wang
- Department of Radiation Oncology, Fourth Hospital of Hebei Medical University, No.12, Jiankang road, Shijiazhuang, 050011, China. .,Hebei Clinical Research Center for Radiation Oncology, Shijiazhuang, China.
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Wang Y, Zhang X, Zhang X, Liu-Helmersson J, Zhang L, Xiao W, Jiang Y, Liu K, Sang S. Prognostic value of the extent of lymphadenectomy for esophageal cancer-specific survival among T1 patients. BMC Cancer 2021; 21:403. [PMID: 33853577 PMCID: PMC8045314 DOI: 10.1186/s12885-021-08080-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Accepted: 03/22/2021] [Indexed: 01/19/2023] Open
Abstract
Background Clinically, there are no clear guidelines on the extent of lymphadenectomy in patients with T1 esophageal cancer. Studying the minimum number of lymph nodes for resection may increase cancer-specific survival. Methods Patients who underwent esophagectomy and lymphadenectomy at T1 stage were selected from the Surveillance, Epidemiology and End Results Program (United States, 1998–2014). Maximally selected rank and Cox proportional hazard models were used to examine three variables: the number of lymph nodes examined, the number of negative lymph nodes and the lymph node ratio. Results Approximately 18% had lymph node metastases, where the median values were 10, 10 and 0 for the number of lymph nodes examined, the number of negative lymph nodes and the lymph node ratio, respectively. All three examined variables were statistically associated with cancer-specific survival probability. Dividing patients into two groups shows a clear difference in cancer-specific survival compared to four or five groups for all three variables: there was a 29% decrease in the risk of death with the number of lymph nodes examined ≥14 vs < 14 (hazard ratio 0.71, 95% confidence interval: 0.57–0.89), a 35% decrease in the risk of death with the number of negative lymph nodes ≥13 vs < 13 (hazard ratio 0.65, 95% confidence interval: 0.52–0.81), and an increase of 1.21 times in the risk of death (hazard ratio 2.21, 95% confidence interval: 1.76–2.77) for the lymph node ratio > 0.05 vs ≤ 0.05. Conclusions The extent of lymph node dissection is associated with cancer-specific survival, and the minimum number of lymph nodes that need to be removed is 14. The number of negative lymph nodes and the lymph node ratio also have prognostic value after lymphadenectomy among T1 stage patients.
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Affiliation(s)
- Yang Wang
- Department of Medical Imaging, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, 250021, People's Republic of China
| | - Xiangwei Zhang
- Department of Thoracic Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, 250021, People's Republic of China
| | - Xiufeng Zhang
- Department of Respiratory and Critical care, Shandong Public Health Clinical Center, Jinan, 250013, People's Republic of China
| | | | - Lin Zhang
- Department of Thoracic Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, 250021, People's Republic of China
| | - Wen Xiao
- Department of Thoracic Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, 250021, People's Republic of China
| | - Yuanzhu Jiang
- Department of Thoracic Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, 250021, People's Republic of China
| | - Keke Liu
- Shandong Institute of Clinical Medicine, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, 250021, People's Republic of China
| | - Shaowei Sang
- Clinical Epidemiology Unit, Qilu Hospital of Shandong University, 107 Wenhua Road, Lixia District, Jinan, 250012, People's Republic of China. .,Clinical Research Center of Shandong University, Jinan, 250012, People's Republic of China. .,Department of Epidemiology and Health Statistics, School of Public Health, Shandong University, Jinan, Shandong, People's Republic of China.
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Zhang G, Guo X, Yuan L, Gao Z, Li J, Li X. Examined lymph node count is not associated with prognosis in elderly patients with pN0 thoracic esophageal cancer. Medicine (Baltimore) 2021; 100:e24100. [PMID: 33466178 PMCID: PMC7808502 DOI: 10.1097/md.0000000000024100] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Accepted: 12/08/2020] [Indexed: 01/05/2023] Open
Abstract
The purpose of this study was to determine whether the number of lymph nodes dissected predicts prognosis in surgically treated elderly patients with pN0 thoracic esophageal cancer. We searched the Surveillance, Epidemiology, and End Results database and identified the records of younger (<75 years) and older (≥75 years) patients with pN0 thoracic esophageal cancer between 1998 and 2015. The patient characteristics, tumor data, and postoperative variables were analyzed in this study. The Kaplan-Meier method and a Cox proportional hazard model were used to compare overall and cause-specific survival. Data from 1,792 esophageal cancer patients (older: n = 295; younger: n = 1497) were included. The survival analysis showed that the overall and cause-specific survival in the patients with ≥15 examined lymph nodes (eLNs) was significantly superior to that in the patients with 1 to 14 eLNs (P < .001); however, the difference disappeared in the older patients. After stratification by the tumor location, histology, pT classification, and differentiation between the younger and older cohorts to analyze the association between eLNs and survival, we found that the differences remained significant in most subgroups in the younger cohort. There were no differences in any subgroups of older patients. This study replicated the previously identified finding that long-term survival in patients with extensive lymphadenectomy was significantly superior to that in patients with less extensive lymphadenectomy. However, less extensive lymphadenectomy may be an acceptable treatment modality for elderly patients with pN0 thoracic esophageal cancer.
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Affiliation(s)
- Guoqing Zhang
- Department of Thoracic Surgery, First Affiliated Hospital of Zhengzhou University, Zhengzhou
| | - Xiaofeng Guo
- Department of Thoracic Surgery, Anyang Tumor Hospital, Anyang, Henan Province, China
| | - Lulu Yuan
- Department of Thoracic Surgery, First Affiliated Hospital of Zhengzhou University, Zhengzhou
| | - Zhen Gao
- Department of Thoracic Surgery, First Affiliated Hospital of Zhengzhou University, Zhengzhou
| | - Jindong Li
- Department of Thoracic Surgery, First Affiliated Hospital of Zhengzhou University, Zhengzhou
| | - Xiangnan Li
- Department of Thoracic Surgery, First Affiliated Hospital of Zhengzhou University, Zhengzhou
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Wu H, Zhuang W, Huang S, Guan X, Zheng Y, Xie Z, Chen G, Tang J, Zhou H, Xie L, Ben X, Zhou Z, Li Z, Chen R, Qiao G. Optimal Range of Lymphadenectomy in Pathological Stage T1 and T2 Esophageal Squamous Cell Carcinoma. Front Oncol 2021; 11:619556. [PMID: 34113556 PMCID: PMC8186312 DOI: 10.3389/fonc.2021.619556] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Accepted: 04/22/2021] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Lymph node metastasis is a primary contributor to tumor progression in esophageal squamous cell carcinoma (ESCC), and the optimal extent of lymphadenectomy during esophagectomy remains controversial. This study aimed to investigate the appropriate number of lymph nodes to be dissected in pT1-2Nany stage ESCC to achieve the best prognosis and avoid missing positive lymph nodes (PLNs). METHODS A total of 497 patients with pT1 to pT2 esophageal cancer from two institutions were retrospectively analyzed and their surgical and pathological records were critically reviewed. Stepwise analyses were conducted by calculating a serial of hazard ratios and odd ratios to determine the optimal range of lymphadenectomy for overall survival (OS). RESULTS The best survival outcome can be obtained when the number of lymph node examined (NLNE) is 10-18 in pT1N0 ESCC, while the NLNE should exceed 24 in pT2N0 diseases. In patients with pT1-2Nany and pT2Nany ESCC, resection of 15-25 and 24-37 lymph nodes, respectively, could provide significant added value for identifying positive nodal metastasis. When the NLNE exceeds this appropriate range, resection of extra lymph node is not helpful to improve the probability of finding PLNs. CONCLUSIONS For ESCC patients undergoing radical esophagectomy, the optimal extent of lymphadenectomy is 15-25 for pT1Nany disease and 24-37 for pT2Nany disease.
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Affiliation(s)
- Hansheng Wu
- Department of Thoracic Surgery, The First Affiliated Hospital of Shantou University Medical College, Shantou, China
- Department of Thoracic Surgery, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Weitao Zhuang
- Department of Thoracic Surgery, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
- Shantou University Medical College, Shantou, China
| | - Shujie Huang
- Department of Thoracic Surgery, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
- Shantou University Medical College, Shantou, China
| | - Xueting Guan
- Department of Thoracic Surgery, The First Affiliated Hospital of Shantou University Medical College, Shantou, China
| | - Yuju Zheng
- Department of Thoracic Surgery, The First Affiliated Hospital of Shantou University Medical College, Shantou, China
| | - Zefeng Xie
- Department of Thoracic Surgery, The First Affiliated Hospital of Shantou University Medical College, Shantou, China
| | - Gang Chen
- Department of Thoracic Surgery, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Jiming Tang
- Department of Thoracic Surgery, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Haiyu Zhou
- Department of Thoracic Surgery, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Liang Xie
- Department of Thoracic Surgery, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Xiaosong Ben
- Department of Thoracic Surgery, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Zihao Zhou
- Department of Thoracic Surgery, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Zijun Li
- Department of Thoracic Surgery, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Rixin Chen
- Department of Thoracic Surgery, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
- Research Center of Medical Sciences, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
- *Correspondence: Guibin Qiao, ; Rixin Chen,
| | - Guibin Qiao
- Department of Thoracic Surgery, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
- Shantou University Medical College, Shantou, China
- *Correspondence: Guibin Qiao, ; Rixin Chen,
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Zhang J, Li H, Zhou L, Yu L, Che F, Heng X. Modified nodal stage of esophageal cancer based on the evaluation of the hazard rate of the negative and positive lymph node. BMC Cancer 2020; 20:1200. [PMID: 33287741 PMCID: PMC7720494 DOI: 10.1186/s12885-020-07664-w] [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: 08/05/2020] [Accepted: 11/18/2020] [Indexed: 12/01/2022] Open
Abstract
Background The study aimed to propose a modified N stage of esophageal cancer (EC) on the basis of the number of positive lymph node (PLN) and the number of negative lymph node (NLN) simultaneously. Method Data from 13,491 patients with EC registered in the SEER database were reviewed. The parameters related to prognosis were investigated using a Cox proportional hazards regression model. A modified N stage was proposed based on the cut-off number of the re-adjusted ratio of the number of PLN (numberPLN) to the number of NLN (numberNLN), which were derived from the comparison of the hazard rate (HR) of numberPLN and numberNLN. The modified N stage was confirmed using the cross-validation method with the training and validation cohort, and it was also compared to the N stage from the American Joint Committee on Cancer (AJCC) staging system (7th edition) using Receiver Operating Characteristic (ROC) curve analysis. Results The numberPLN on prognosis was 1.042, while numberNLN was 0.968. The modified N stage was defined as follows: N1 stage: the ratio range was from 0 to 0.21; N2 stage: more than 0.21, but no more than 0.48; N3 stage: more than 0.48. The log-rank test indicated that significant survival differences were confirmed among the N1, N2 and N3 sub-groups of patients in the training population. The difference of all the patients using the modified N stage method were more significant than AJCC N stage. The result of ROC analysis indicated that the modified N stage could represent the N stage of EC more accurately. Conclusion The modified N stage based on the re-adjusted ratio of numberPLN to numberNLN can evaluate tumor stage more accurately than the traditional N stage.
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Affiliation(s)
- Jinling Zhang
- Cancer Center of Linyi People's Hospital, Shandong University, School of Medicine, Linyi, 276000, Shandong Province, P. R. China
| | - Hongyan Li
- Department of Central Laboratory, Linyi People's hospital, Shandong University, School of medicine, Linyi, 276000, Shandong Province, P. R. China
| | - Liangjian Zhou
- Cancer Center of Linyi People's Hospital, Shandong University, School of Medicine, Linyi, 276000, Shandong Province, P. R. China
| | - Lianling Yu
- Cancer Center of Linyi People's Hospital, Shandong University, School of Medicine, Linyi, 276000, Shandong Province, P. R. China
| | - Fengyuan Che
- Department of Central Laboratory, Linyi People's hospital, Shandong University, School of medicine, Linyi, 276000, Shandong Province, P. R. China
| | - Xueyuan Heng
- Cancer Center of Linyi People's Hospital, Shandong University, School of Medicine, Linyi, 276000, Shandong Province, P. R. China.
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Zheng YZ, Li XQ, Wang JY, Yang H, Wen J, Zhai WY, Yuan LX, Fu SS, Liao HY, Fu JH. Impact of Examined Lymph Node Count for Esophageal Squamous Cell Carcinoma in Patients who Underwent Right Transthoracic Esophagectomy. Ann Surg Oncol 2020; 28:3025-3033. [PMID: 33073346 DOI: 10.1245/s10434-020-09217-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2019] [Accepted: 09/12/2020] [Indexed: 11/18/2022]
Abstract
BACKGROUND The impact of the number of examined lymph nodes (ELNs) on stage correction and prognostication in patients with esophageal squamous cell carcinoma (ESCC) who underwent right transthoracic esophagectomy is still unclear. METHODS Patients with ESCC who underwent right transthoracic esophagectomy at Sun Yat-sen University Cancer Center between January 1997 and December 2013 were retrospectively enrolled. The Cox proportional hazards regression model was used to determine the effect of ELN count on overall survival. The impact of ELN count on stage correction was evaluated using the hypergeometric distribution and Bayes theorem and β-binomial distribution estimation, respectively. The threshold of ELNs was determined using the LOWESS smoother and piecewise linear regression. RESULTS Among the 875 included patients, greater ELNs were associated with a higher rate of nodal metastasis. Significant association between staging bias and the number of ELNs is only observed through the Bayes method. The ELN count did not impact 90-day mortality but significantly impacted long-term survival (adjusted hazard ratio [aHR] 0.986), especially in those patients with node-negative disease (aHR 0.972). In patients with node-negative disease, cut-point analysis showed a threshold ELN count of 21. CONCLUSIONS A greater number of ELNs is associated with more accurate node staging and better long-term survival in resected ESCC patients. We recommended harvesting at least 21 LNs to acquire accurate staging and long-term survival information for patients with declared node-negative disease using the right thoracic approach.
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Affiliation(s)
- Yu-Zhen Zheng
- Department of Thoracic Oncology, State Key Laboratory of Oncology in South China, Collaborative Innovation, Sun Yat-sen University Cancer Center, No.651, Dongfeng Road East, Guangzhou, 510060, Guangdong, China.,Department of Thoracic Surgery, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Xiao-Qiang Li
- Department of Thoracic Surgery, Peking University Shenzhen Hospital, Shenzhen, China
| | - Jun-Ye Wang
- Department of Thoracic Oncology, State Key Laboratory of Oncology in South China, Collaborative Innovation, Sun Yat-sen University Cancer Center, No.651, Dongfeng Road East, Guangzhou, 510060, Guangdong, China
| | - Hong Yang
- Department of Thoracic Oncology, State Key Laboratory of Oncology in South China, Collaborative Innovation, Sun Yat-sen University Cancer Center, No.651, Dongfeng Road East, Guangzhou, 510060, Guangdong, China
| | - Jing Wen
- Department of Thoracic Oncology, State Key Laboratory of Oncology in South China, Collaborative Innovation, Sun Yat-sen University Cancer Center, No.651, Dongfeng Road East, Guangzhou, 510060, Guangdong, China
| | - Wen-Yu Zhai
- Department of Thoracic Oncology, State Key Laboratory of Oncology in South China, Collaborative Innovation, Sun Yat-sen University Cancer Center, No.651, Dongfeng Road East, Guangzhou, 510060, Guangdong, China
| | - Lian-Xiong Yuan
- Office of Research Service, Third Affiliation Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Shen-Shen Fu
- Department of Ultrasonography, Guangzhou First People's Hospital, Guangzhou Medical University, Guangzhou, China
| | - Hong-Ying Liao
- Department of Thoracic Surgery, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.
| | - Jian-Hua Fu
- Department of Thoracic Oncology, State Key Laboratory of Oncology in South China, Collaborative Innovation, Sun Yat-sen University Cancer Center, No.651, Dongfeng Road East, Guangzhou, 510060, Guangdong, China.
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12
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Zheng YZ, Li XQ, Wang JY, Yang H, Wen J, Zhai WY, Yuan LX, Fu SS, Liao HY, Fu JH. Impact of examined lymph node count for oesophageal squamous cell carcinoma in patients who underwent left transthoracic oesophagectomy. Eur J Surg Oncol 2020; 46:1956-1962. [PMID: 32439262 DOI: 10.1016/j.ejso.2020.04.047] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Revised: 02/22/2020] [Accepted: 04/25/2020] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND The impact of the number of examined lymph nodes (ELNs) on stage correction and prognostication in patients with oesophageal squamous cell carcinoma (ESCC) who underwent left transthoracic oesophagectomy is still unclear. METHODS Patients with ESCC who underwent left transthoracic oesophagectomy at Sun Yat-sen University Cancer Center between January 1997 and December 2013 were retrospectively enrolled. The Cox proportional hazards regression model was used to determine the effect of ELN count on overall survival (OS). The association between ELN count and nodal status was investigated through scatter plot and binary logistic regression analyses. The impact of ELN count on stage correction was evaluated using the hypergeometric distribution and Bayes theorem. The threshold of ELNs was determined using the LOWESS smoother and piecewise linear regression. RESULTS Among the 1826 included patients, greater ELNs were associated with a higher rate of nodal metastasis (adjusted OR = 1.018). When the ELN count increased, the omission rate of positive lymph nodes (LNs) decreased. The ELN count did not impact 90-day mortality but significantly impacted long-term survival (adjusted HR = 0.983), especially in those with node-negative disease (adjust HR = 0.972). In patients with node-negative disease, cut point analysis showed a threshold ELN count of 18. CONCLUSIONS A greater number of ELNs is associated with more accurate node staging and better long-term survival in resected ESCC patients. We recommended harvesting at least 18 LNs to acquire accurate staging and long-term survival information for patients with declared node-negative disease in the left thoracic approach.
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Affiliation(s)
- Yu-Zhen Zheng
- Department of Thoracic Surgery, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Guangdong Esophageal Cancer Institute, Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong, China; Department of Thoracic Surgery, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Xiao-Qiang Li
- Department of Thoracic Surgery, Peking University Shenzhen Hospital, Shenzhen, China
| | - Jun-Ye Wang
- Department of Thoracic Surgery, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Guangdong Esophageal Cancer Institute, Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong, China
| | - Hong Yang
- Department of Thoracic Surgery, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Guangdong Esophageal Cancer Institute, Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong, China
| | - Jing Wen
- Department of Thoracic Surgery, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Guangdong Esophageal Cancer Institute, Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong, China
| | - Wen-Yu Zhai
- Department of Thoracic Surgery, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Guangdong Esophageal Cancer Institute, Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong, China
| | - Lian-Xiong Yuan
- Office of Research Service, Third Affiliation Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Shen-Shen Fu
- Department of Ultrasonography, Guangzhou First People's Hospital, the Second Affiliated Hospital of South China University of Technology, Guangzhou, China
| | - Hong-Ying Liao
- Department of Thoracic Surgery, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.
| | - Jian-Hua Fu
- Department of Thoracic Surgery, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Guangdong Esophageal Cancer Institute, Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong, China.
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Zhan C, Shi Y, Jiang W, Sun F, Li M, Lu T, Yin J, Ma K, Yang X, Wang Q. How many lymph nodes should be dissected in esophagectomy with or without neoadjuvant therapy to get accurate staging? Dis Esophagus 2020; 33:5475049. [PMID: 30997490 DOI: 10.1093/dote/doz009] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Revised: 01/15/2019] [Accepted: 02/05/2019] [Indexed: 12/11/2022]
Abstract
It is essential to dissect an adequate number of lymph nodes (LNs) to ensure staging accuracy during esophagectomy with or without neoadjuvant therapy. We developed a statistical model to quantify the probability of precise nodal staging based on previous studies. Esophageal cancer patients who underwent esophagectomy were retrospectively reviewed in the Surveillance, Epidemiology, and End Results database. A β-binomial distribution was adopted to estimate the number of understaged patients based on the numbers of positive and examined LNs. Using 6,252 patients, we estimated a 90% confidence of accurate N0 staging could be achieved by examining 17 LNs without neoadjuvant therapy. To obtain similar accuracy in N1 and N2, 20 and 25 LNs should be examined. For patients with neoadjuvant therapy, 18, 19, and 28 LNs could achieve the same accuracy. Staging accuracy was a significant prognostic factor. We found when 90% confidence had been achieved, patient survival did not improve with more LNs examined and the ratio and log odds of positive LNs did not have significant prognostic values. The statistical model we developed for precise staging in patients with different N stages is of great value in guiding lymphadenectomy. It provided risk assessment for underestimated LN metastases and guided subsequent adjuvant treatment.
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Affiliation(s)
- C Zhan
- Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Y Shi
- Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - W Jiang
- Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - F Sun
- Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - M Li
- Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - T Lu
- Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - J Yin
- Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - K Ma
- Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - X Yang
- Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Q Wang
- Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
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14
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Prognostic Value of Lymph Node Yield on Overall Survival in Esophageal Cancer Patients: A Systematic Review and Meta-analysis. Ann Surg 2019; 269:261-268. [PMID: 29794846 DOI: 10.1097/sla.0000000000002824] [Citation(s) in RCA: 86] [Impact Index Per Article: 17.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVE This meta-analysis determines whether increased lymph node yield improves survival in patients with esophageal cancer undergoing esophagectomy with or without neoadjuvant therapy. BACKGROUND Esophagectomy involves resection of the esophagus and surrounding lymph nodes, which are commonly the first stations of cancer spread. The extent of lymphadenectomy during esophagectomy remains controversial, with several studies publishing conflicting results, especially in the era of neoadjuvant therapy. METHODS An electronic literature search was undertaken using Embase, Medline, and the Cochrane library databases (2000 to 2017). Articles with esophageal cancer patients undergoing esophagectomy with lymphadenectomy and investigating the effects of low and high lymph node yield on overall survival and disease-free survival were included. Meta-analysis of data was conducted using a random effects model. If the study divided the cohort into multiple groups based on lymph node yield, survival was compared between the lowest and highest lymph node yield groups. In addition to analysis of the entire cohort, subset analysis of only those patients receiving neoadjuvant therapy was also performed. RESULTS A total of 26 studies were included in this meta-analysis with a follow-up ranging from 15 to 94 months. For the analysis of overall survival, 23 studies were included. A meta-analysis showed that overall survival significantly improved in the high lymph node yield group [hazard ratio (HR) = 0.81; 95% confidence interval (95% CI) = 0.74-0.87; P < 0.01]. In the 10 studies describing disease-free survival, this was significantly improved in the high lymph node yield group (HR = 0.72; 95% CI = 0.62-0.84; P < 0.01). Subset analysis of neoadjuvant-treated patients demonstrated a survival benefit of high lymph node yield on overall survival (HR = 0.82; 95% CI = 0.73-0.92; P < 0.01). CONCLUSION This meta-analysis demonstrates the benefit of an increased lymph node yield from esophagectomy on overall and disease-free survival. In addition, a survival benefit of a high lymph node yield was demonstrated in patients receiving neoadjuvant therapy followed by esophagectomy.
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15
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Shi Y, Xu J, Wang Y, Tang J, Zhang C, Lv W, Hu J. Prognostic significance of preoperative lymph node assessment for patients with stage pN0 esophageal squamous cell carcinoma after esophagectomy. J Thorac Dis 2019; 11:732-743. [PMID: 31019761 DOI: 10.21037/jtd.2019.02.25] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Background Accurate preoperative lymph node (LN) staging is important for surgical treatments of esophageal squamous cell carcinoma (ESCC). The aim of the study was to investigate the role of preoperative lymph nodes assessment by computed tomography (CT) scans in prognostic estimates and lymph nodes dissection strategy. Methods A total of 233 stage pN0 ESCC patients who underwent radical esophagectomy from 2009 to 2016 were included, with the last follow-up time in 2018. Survival analysis was conducted to assess the relationship between preoperative clinical LN metastasis and the prognosis of patients with pN0 ESCC. Results Ninety-nine patients were classified as clinical positive LN metastasis by CT scans, but were confirmed as stage N0 by postoperative pathological examination, and survival analysis suggested that these patients had relatively poorer prognosis (P=0.027). Cox regression analysis indicated that the clinical LN metastasis on CT scans was an independent negative prognostic factor for patients with pN0 ESCC (P=0.031). The number of LNs dissected affected the prognosis of pN0 patients. Patients with positive LN metastasis on CT would have better prognosis when the number of dissected LNs was equal to or more than 15 LNs (P=0.036). Especially for patients with higher T stage, they were would obtain prognostic benefit with at least 17 LNs dissected (P=0.037). On the other hand, for those with negative LN metastasis on CT, at least 12 LNs dissected indicated better prognosis (P=0.019). Conclusions Preoperative LN assessment for ESCC patients is critically important, the optimal LN dissection number should refer to the preoperative CT performance.
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Affiliation(s)
- Yan Shi
- Department of Thoracic Surgery, the First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310003, China
| | - Jinming Xu
- Department of Thoracic Surgery, the First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310003, China
| | - Ying Wang
- Operating Room, the First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310003, China
| | - Jie Tang
- Department of Thoracic Surgery, the First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310003, China
| | - Chong Zhang
- Department of Thoracic Surgery, the First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310003, China
| | - Wang Lv
- Department of Thoracic Surgery, the First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310003, China
| | - Jian Hu
- Department of Thoracic Surgery, the First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310003, China
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Negative lymph node at station 108 is a strong predictor of overall survival in esophageal cancer. Oncol Lett 2018; 16:6705-6712. [PMID: 30405812 DOI: 10.3892/ol.2018.9456] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2017] [Accepted: 04/06/2018] [Indexed: 12/23/2022] Open
Abstract
A negative lymph node (NLN) may represent a stronger predictor for the overall survival (OS) rate of patients with esophageal squamous cell carcinoma (ESCC), when compared with a positive LN (PLN). The present study aimed to investigate which LN station, containing the NLN, was associated with OS rate. A retrospective review was conducted in 216 patients with ESCC and a forward stepwise Cox regression model analysis was used to assess the relationship between clinical parameters and OS rate. Patients were divided into subgroups according to the status of the LN at station 108. Survival analysis was performed using the Kaplan-Meier method. The ratio of albumin-to-globulin (AGR), and of lymphocytes to neutrophil granulocytes (LNR) in the subgroups were also investigated. Overall, 105p (the PLN number at station 105), 108p, 109p and 7p were confirmed to be risk factors for OS rate (all P<0.05). Conversely, 108n (the NLN number at station 108) was identified as a protective factor for OS rate [hazard ratio (HR) 0.457, P=0.001]. Survival analysis demonstrated that patients with an NLN identified at the station 108 had an improved OS rate compared with those with a PLN identified at station 108 (P=0.006). Patients with only an NLN identified at station 108 had the best OS rate among all the sub-groups examined, and the AGR of this group of patients was higher than those of the other groups. The LN status at station 108 may indicate the prognosis of patients with ESCC, and an NLN may reflect the reaction of the immune system to tumor metastasis in these patients.
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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
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Wu SG, Sun JY, Yang LC, Zhou J, Li FY, Li Q, Lin HX, Lin Q, He ZY. Prognosis of patients with esophageal squamous cell carcinoma after esophagectomy using the log odds of positive lymph nodes. Oncotarget 2017; 6:36911-22. [PMID: 26426993 PMCID: PMC4742220 DOI: 10.18632/oncotarget.5366] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2015] [Accepted: 09/17/2015] [Indexed: 12/14/2022] Open
Abstract
To compare the log odds of positive lymph nodes (LODDS) with the number of positive lymph nodes (pN), lymph node ratio (LNR), removed lymph node (RLN) count, and negative lymph node (NLN) count in determining the prognosis of patients with esophageal squamous cell carcinoma (ESCC) after esophagectomy. The records of patients with ESCC who received esophagectomy were retrospectively reviewed. The log-rank test was used to compare curves for overall survival (OS), and Cox regression analysis was performed to identify prognostic factors. The prognostic performance of the different lymph node staging systems were compared using the linear trend chi-square test, likelihood ratio chi-square test, and Akaike information criterion. A total of 589 patients were enrolled. Univariate Cox analysis showed that pN stage, LNR, RLN count, NLN count, and the LODDS were significantly associated with OS (p < 0.05 for all). Multivariate Cox analysis adjusted for significant factors indicated that LODDS was independent risk factor on overall survival (OS), and a higher LODDS was associated with worse OS (hazard ratio = 3.297, 95% confidence interval: 2.684–4.050, p < 0.001). The modified Tumor-LODDS-Metastasis staging system had better discriminatory ability, monotonicity, and homogeneity, and better optimistic prognostic stratification than the Tumor-Node-Metastasis staging system in determining the prognosis of patients with ESCC. The LODDS staging system was superior to other lymph node classifications in determining the prognosis of patients with ESCC after esophagectomy. LODDS may be incorporated into esophageal staging system if these results are eventually confirmed by other studies.
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Affiliation(s)
- San-Gang Wu
- Xiamen Cancer Center, Department of Radiation Oncology, The First Affiliated Hospital of Xiamen University, Xiamen, People's Republic of China
| | - Jia-Yuan Sun
- Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Department of Radiation Oncology, Collaborative Innovation Center of Cancer Medicine, Guangzhou, People's Republic of China
| | - Li-Chao Yang
- Department of Basic Medical Science, Medical College, Xiamen University, Xiamen, People's Republic of China
| | - Juan Zhou
- Xiamen Cancer Center, Department of Obstetrics and Gynecology, The First Affiliated Hospital of Xiamen University, Xiamen, People's Republic of China
| | - Feng-Yan Li
- Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Department of Radiation Oncology, Collaborative Innovation Center of Cancer Medicine, Guangzhou, People's Republic of China
| | - Qun Li
- Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Department of Radiation Oncology, Collaborative Innovation Center of Cancer Medicine, Guangzhou, People's Republic of China
| | - Huan-Xin Lin
- Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Department of Radiation Oncology, Collaborative Innovation Center of Cancer Medicine, Guangzhou, People's Republic of China
| | - Qin Lin
- Xiamen Cancer Center, Department of Radiation Oncology, The First Affiliated Hospital of Xiamen University, Xiamen, People's Republic of China
| | - Zhen-Yu He
- Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Department of Radiation Oncology, Collaborative Innovation Center of Cancer Medicine, Guangzhou, People's Republic of China
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Busweiler LAD, Schouwenburg MG, van Berge Henegouwen MI, Kolfschoten NE, de Jong PC, Rozema T, Wijnhoven BPL, van Hillegersberg R, Wouters MWJM, van Sandick JW. Textbook outcome as a composite measure in oesophagogastric cancer surgery. Br J Surg 2017; 104:742-750. [PMID: 28240357 DOI: 10.1002/bjs.10486] [Citation(s) in RCA: 171] [Impact Index Per Article: 24.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2016] [Revised: 07/19/2016] [Accepted: 12/08/2016] [Indexed: 01/26/2023]
Abstract
BACKGROUND Quality assurance is acknowledged as a crucial factor in the assessment of oncological surgical care. The aim of this study was to develop a composite measure of multiple outcome parameters defined as 'textbook outcome', to assess quality of care for patients undergoing oesophagogastric cancer surgery. METHODS Patients with oesophagogastric cancer, operated on with the intent of curative resection between 2011 and 2014, were identified from a national database (Dutch Upper Gastrointestinal Cancer Audit). Textbook outcome was defined as the percentage of patients who underwent a complete tumour resection with at least 15 lymph nodes in the resected specimen and an uneventful postoperative course, without hospital readmission. Hospital variation in textbook outcome was analysed after adjustment for case-mix factors. RESULTS In total, 2748 patients with oesophageal cancer and 1772 with gastric cancer were included in this study. A textbook outcome was achieved in 29·7 per cent of patients with oesophageal cancer and 32·1 per cent of those with gastric cancer. Adjusted textbook outcome rates varied from 8·5 to 52·4 per cent between hospitals. The outcome parameter 'at least 15 lymph nodes examined' had the greatest negative impact on a textbook outcome both for patients with oesophageal cancer and for those with gastric cancer. CONCLUSION Most patients did not achieve a textbook outcome and there was wide variation between hospitals.
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Affiliation(s)
- L A D Busweiler
- Dutch Institute for Clinical Auditing, Leiden University Medical Centre, Leiden, The Netherlands.,Department of General Surgery, Leiden University Medical Centre, Leiden, The Netherlands
| | - M G Schouwenburg
- Dutch Institute for Clinical Auditing, Leiden University Medical Centre, Leiden, The Netherlands.,Department of General Surgery, Leiden University Medical Centre, Leiden, The Netherlands
| | | | - N E Kolfschoten
- Dutch Institute for Clinical Auditing, Leiden University Medical Centre, Leiden, The Netherlands
| | - P C de Jong
- Department of Medical Oncology, St Antonius Hospital, Nieuwegein, The Netherlands
| | - T Rozema
- Department of Radiation Oncology, Institute Verbeeten, Tilburg, The Netherlands
| | - B P L Wijnhoven
- Department of General Surgery, Erasmus Medical Centre, Rotterdam, The Netherlands
| | - R van Hillegersberg
- Department of General Surgery, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - M W J M Wouters
- Dutch Institute for Clinical Auditing, Leiden University Medical Centre, Leiden, The Netherlands.,Department of Surgical Oncology, The Netherlands Cancer Institute/Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - J W van Sandick
- Department of Surgical Oncology, The Netherlands Cancer Institute/Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
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Metastatic lymph node ratio demonstrates better prognostic stratification than pN staging in patients with esophageal squamous cell carcinoma after esophagectomy. Sci Rep 2016; 6:38804. [PMID: 27941828 PMCID: PMC5150247 DOI: 10.1038/srep38804] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2016] [Accepted: 11/15/2016] [Indexed: 12/19/2022] Open
Abstract
This study aimed to evaluate the prognostic significance of lymph node ratio (LNR) by establishing a hypothetical tumor-ratio-metastasis (TRM) staging system in patients with esophageal squamous cell carcinoma (ESCC). The records of 387 ESCC patients receiving curative esophagectomy were retrospectively investigated. The optimal cut-point for LNR was assessed via the best cut-off approach. Potential prognostic parameters were identified through univariate and multivariate analyses. A novel LNR-based TRM stage was proposed. The prognostic discriminatory ability and prediction accuracy of each system were determined using hazard ratio (HR), Akaike information criterion (AIC), concordance index (C-index), and area under the receiver operating characteristic curve (AUC). The optimal cut-points of LNR were set at 0, 0~0.2, 0.2~0.4, and 0.4~1.0. Multivariate Cox analysis indicated that the LNR category was an independent risk factor of overall survival (P < 0.001). The calibration curves for the probability of 3- and 5-year survival showed good consistency between nomogram prediction and actual observation. The LNR category and TRM stage yielded a larger HR, a smaller AIC, a larger C-index, and a larger AUC than the N category and TNM stage did. In summary, the proposed LNR category was superior to the conventional N category in predicting the prognosis of ESCC patients.
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Yang PW, Hsu IJ, Chang CW, Wang YC, Hsieh CY, Shih KH, Wong LF, Shih NY, Hsieh MS, Hou MTK, Lee JM. Visible-absorption spectroscopy as a biomarker to predict treatment response and prognosis of surgically resected esophageal cancer. Sci Rep 2016; 6:33414. [PMID: 27624872 PMCID: PMC5022060 DOI: 10.1038/srep33414] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2016] [Accepted: 08/30/2016] [Indexed: 12/19/2022] Open
Abstract
The application of optical absorption spectra in prognostic prediction has hardly been investigated. We developed and evaluated a novel two dimensional absorption spectrum measurement system (TDAS) for use in early diagnosis, evaluating response to chemoradiation, and making prognostic prediction. The absorption spectra of 120 sets of normal and tumor tissues from esophageal cancer patients were analyzed with TDAS ex-vivo. We demonstrated the cancerous tissue, the tissue from patients with a poor concurrent chemoradiotherapy (CCRT) response, and the tissue from patients with an early disease progression each had a readily identifiable common spectral signature. Principal component analysis (PCA) classified tissue spectra into distinct groups, demonstrating the feasibility of using absorption spectra in differentiating normal and tumor tissues, and in predicting CCRT response, poor survival and tumor recurrence (efficiencies of 75%, 100% and 85.7% respectively). Multivariate analysis revealed that patients identified as having poor-response, poor-survival and recurrence spectral signatures were correlated with increased risk of poor response to CCRT (P = 0.012), increased risk of death (P = 0.111) and increased risk of recurrence (P = 0.030) respectively. Our findings suggest that optical absorption microscopy has great potential to be a useful tool for pre-operative diagnosis and prognostic prediction of esophageal cancer.
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Affiliation(s)
- Pei-Wen Yang
- Department of Surgery, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - I-Jen Hsu
- Department of Physics and Center for Biomedical Technology, Chung Yuan Christian University, Taoyuan, Taiwan
| | - Chun-Wei Chang
- Department of Physics and Center for Biomedical Technology, Chung Yuan Christian University, Taoyuan, Taiwan
| | - Yu-Chia Wang
- Department of Physics and Center for Biomedical Technology, Chung Yuan Christian University, Taoyuan, Taiwan
| | - Ching-Yueh Hsieh
- Department of Surgery, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Kuan-Hui Shih
- Department of Surgery, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Li-Fan Wong
- Department of Surgery, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Nai-Yu Shih
- Department of Surgery, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Min-Shu Hsieh
- Graduate Institute of Pathology, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Max Ti-Kuang Hou
- Department of Mechanical Engineering, National United University, Miaoli, Taiwan
| | - Jang-Ming Lee
- Department of Surgery, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
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Ye B, Zhong CX, Yang Y, Fang WT, Mao T, Ji CY, Li ZG. Lymph node dissection in esophageal carcinoma: Minimally invasive esophagectomy vs open surgery. World J Gastroenterol 2016; 22:4750-4756. [PMID: 27217706 PMCID: PMC4870081 DOI: 10.3748/wjg.v22.i19.4750] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2016] [Revised: 02/25/2016] [Accepted: 03/14/2016] [Indexed: 02/06/2023] Open
Abstract
AIM: To compare lymph node dissection results of minimally invasive esophagectomy (MIE) and open surgery for esophageal squamous cell carcinoma.
METHODS: We retrospectively reviewed data from patients who underwent MIE or open surgery for esophageal squamous cell carcinoma from January 2011 to September 2014. Number of lymph nodes resected, positive lymph node (pN+) rate, lymph node sampling (LNS) rate and lymph node metastatic (LNM) rate were evaluated.
RESULTS: Among 447 patients included, 123 underwent MIE and 324 underwent open surgery. The number of lymph nodes resected did not significantly differ between the MIE and open surgery groups (21.1 ± 4.3 vs 20.4 ± 3.8, respectively, P = 0.0944). The pN+ rate of stage T3 esophageal squamous cell carcinoma in the open surgery group was higher than that in the MIE group (16.3% vs 11.4%, P = 0.031), but no differences was observed for stages T1 and T2 esophageal squamous cell carcinoma. The LNS rate at left para-recurrent laryngeal nerve (RLN) site was significantly higher for open surgery than for MIE (80.2% vs 43.9%, P < 0.001), but no differences were noted at other sites. The LNM rate at left para-RLN site in the open surgery group was significantly higher than that in the MIE group, regardless of pathologic T stage.
CONCLUSION: For stages T1 and T2 esophageal squamous cell carcinoma, the lymph node dissection result after MIE was comparable to that achieved by open surgery. However, the efficacy of MIE in lymphadenectomy for stage T3 esophageal squamous cell carcinoma, particularly at left para-RLN site, remains to be improved.
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Peng J, Wang WP, Yuan Y, Wang ZQ, Wang Y, Chen LQ. Adequate lymphadenectomy in patients with oesophageal squamous cell carcinoma: resecting the minimal number of lymph node stations. Eur J Cardiothorac Surg 2016; 49:e141-6. [PMID: 26905182 DOI: 10.1093/ejcts/ezw015] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2015] [Accepted: 01/11/2016] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVES The seventh edition of the American Joint Committee on Cancer (AJCC) tumour-node-metastasis (TNM) staging system for oesophageal cancer did not define the minimal requirement for an adequate extent of lymphadenectomy in patients with oesophageal cancer. This study aimed to define the minimum number of lymph node (LN) stations to be resected in patients with oesophageal squamous cell carcinoma (OSCC). METHODS We conducted a retrospective review of clinicopathological data from 2033 patients with OSCC undergoing complete resection between August 2005 and September 2013. An ordinal logistic regression analysis was used to identify the variables associated with revised N (rN) staging progression and indices that could be used in the stratified analysis. To determine the optimal number of resected LN stations, we compared the overall survival hazard ratio between groups with different numbers of LN stations using a Cox's proportional hazards regression model. The highest χ(2) value was deemed the cut-off point. RESULTS The progression of rN staging was influenced by T-staging, G-staging, tumour length (>3 cm), lymphovascular invasion and number of resected LN stations. According to Cox's proportional hazards regression model, we recommended that at least six LN stations should be removed. Then, we conducted a stratified analysis by G status and tumour length. We found that at least seven LN stations should be removed in patients with G3 or tumour length >3 cm. CONCLUSIONS For thoracic OSCC, at least six LN stations had to be removed. Furthermore, for patients with G3 or tumour length >3 cm, the recommendation was seven.
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Affiliation(s)
- Jun Peng
- 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
| | - Zhi-Qiang Wang
- Department of Thoracic Surgery, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Yun Wang
- 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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Peng J, Wang WP, Dong T, Cai J, Ni PZ, Chen LQ. Refining the Nodal Staging for Esophageal Squamous Cell Carcinoma Based on Lymph Node Stations. Ann Thorac Surg 2016; 101:280-6. [DOI: 10.1016/j.athoracsur.2015.06.081] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2015] [Revised: 06/15/2015] [Accepted: 06/22/2015] [Indexed: 12/15/2022]
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Patterns of Regional Lymph Node Recurrence After Radical Surgery for Thoracic Esophageal Squamous Cell Carcinoma. Ann Thorac Surg 2015; 101:551-7. [PMID: 26530541 DOI: 10.1016/j.athoracsur.2015.08.057] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2015] [Revised: 08/03/2015] [Accepted: 08/07/2015] [Indexed: 11/23/2022]
Abstract
BACKGROUND This study aimed to investigate the patterns of regional lymph node recurrence after radical surgery for thoracic esophageal squamous cell carcinoma (ESCC). METHODS We retrospectively reviewed clinical characteristics of ESCC patients admitted to two institutions from 1990 to 2011, and analyzed the patterns of regional lymph node recurrence. RESULTS The records of 315 eligible patients with ESCC were reviewed. Of the 378 regional lymph node recurrence sites, 177 (46.8%) were in the supraclavicular areas, 120 (31.7%) in the mediastinum, and 81 (21.4%) in the upper abdominal areas. The most common sites of recurrence were the supraclavicular and mediastinum areas in patients with upper and middle thoracic ESCC. Approximately equal percentages of patients with lower thoracic tumors had supraclavicular, mediastinal, and upper abdominal (celiac) lymph node recurrence. Patients with tumor located in the lower thoracic esophagus had a lower probability of supraclavicular lymph node recurrence (p = 0.013). None of the assessed factors was associated with mediastinal lymph node recurrence. Celiac lymph node recurrence was more frequent among patients with lower thoracic ESCC (p = 0.004) and advanced pathologic nodal (pN) stage (pN2, p = 0.034; pN3, p = 0.009). CONCLUSIONS After radical surgery for thoracic ESCC, the patterns of regional lymph node recurrence are related to the tumor location and pN stage.
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Wei C, Deng WY, Li N, Shen W, Zhang C, Liu JY, Luo SX. Lymph Node Ratio as an Alternative to the Number of Metastatic Lymph Nodes for the Prediction of Esophageal Carcinoma Patient Survival. Dig Dis Sci 2015; 60:2771-6. [PMID: 25939544 DOI: 10.1007/s10620-015-3681-1] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2015] [Accepted: 04/20/2015] [Indexed: 12/09/2022]
Abstract
BACKGROUND The prognostic value of metastatic lymph node ratio (LNR) is still controversial in esophageal cancer. AIM This study aimed to compare the impact of AJCC N staging system (pN) and LNR on the prediction of long-term survival of patients with esophageal carcinoma. METHODS A total of 496 patients were retrospectively analyzed who underwent esophageal resection at Henan Tumor Hospital from January 2006 to December 2010. The Kaplan-Meier method and log-rank test were used to estimate survival curves. Univariate and multivariate analyses were performed to compare prognostic factors for long-term survival. The difference between pN and LNR with overall survival (OS) was compared by receiver operating characteristic (ROC) curve and area under the curve (AUC). RESULTS The 1-, 3-, 5-year overall survival rates of 496 patients were 73.6, 47.1 and 34.2 %, respectively. Univariate analyses showed that diseased region, tumor length, depth of tumor invasion, pN and LNR affected the prognosis, and multivariate analyses demonstrated that depth of tumor invasion, pN and LNR were independent risk factors. Among the three significant variables verified by multivariate analyses, LNR was the best for inadequately staged patients (<12 examined LNs). ROC analyses showed that compared with pN (AUC = 0.579, p = 0.037), LNR (AUC = 0.680, p = 0.002) had better predictive value (z = 2.275, p = 0.029). CONCLUSIONS LNR has greater prognostic value than pN for esophageal squamous cell carcinoma, especially for patients with <12 LNs removed.
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Affiliation(s)
- Chen Wei
- Department of Internal Medicine-Oncology, Henan Cancer Hospital, The Affiliated Cancer Hospital of Zhengzhou University, No. 127, Dongming Road, Zhengzhou, 450000, Henan Province, People's Republic of China
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Luna RA, Dolan JP, Diggs BS, Bronson NW, Sheppard BC, Schipper PH, Tieu BH, Feeney BT, Gatter KM, Vaccaro GM, Thomas CR, Hunter JG. Lymph Node Harvest During Esophagectomy Is Not Influenced by Use of Neoadjuvant Therapy or Clinical Disease Stage. J Gastrointest Surg 2015; 19:1201-7. [PMID: 25910454 DOI: 10.1007/s11605-015-2821-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2014] [Accepted: 04/07/2015] [Indexed: 02/07/2023]
Abstract
INTRODUCTION The purpose of this study was to evaluate the effects of neoadjuvant therapy on lymph node harvest (LNH), lymph node ratio (LNR), and overall survival rates after esophagectomy. METHODS A retrospective analysis of 111 patients who underwent esophagectomy for esophageal adenocarcinoma from 2001 to 2010 was performed. Patients were divided into two groups: neoadjuvant chemoradiotherapy prior to surgery (NEOSURG) versus surgery alone (SURG). RESULTS There were 83 patients (75%) in the NEOSURG group and 28 (25%) in the SURG group with a mean age of 66 and 67 years, respectively. The median LNH in the NEOSURG group and SURG group was 16.0 and 15.5, respectively (p = 0.57). Within the NEOSURG group, the median LNH was 16 for complete responders, 14 for partial responders, 16 for nonresponders, and 18 in those who were pathologically upstaged (p = 0.434). The median LNR was 0, 0, 0.1, and 0.2, respectively (p < 0.001). Complete response after neoadjuvant therapy demonstrated a trend toward improved survival (p = 0.056). CONCLUSION The LNH was not significantly influenced by neoadjuvant treatment or pathologic response. The LNR was inversely related to pathologic response after neoadjuvant therapy. Complete pathologic response to neoadjuvant therapy trends to improve survival rates.
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Affiliation(s)
- Renato A Luna
- Department of Surgery, the Digestive Health Center and the Knight Cancer Institute, Oregon Health and Science University, 3181 SW Sam Jackson Park Road, Mail code L223A, Portland, OR, 97239, USA
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Chen SB, Weng HR, Wang G, Zou XF, Liu DT, Chen YP, Zhang H. Lymph node ratio-based staging system for esophageal squamous cell carcinoma. World J Gastroenterol 2015; 21:7514-7521. [PMID: 26139998 PMCID: PMC4481447 DOI: 10.3748/wjg.v21.i24.7514] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2014] [Revised: 01/06/2015] [Accepted: 03/19/2015] [Indexed: 02/06/2023] Open
Abstract
AIM: To analyze a modified staging system utilizing lymph node ratio (LNR) in patients with esophageal squamous cell carcinoma (ESCC).
METHODS: Clinical data of 2011 patients with ESCC who underwent surgical resection alone between January 1995 and June 2010 at the Cancer Hospital of Shantou University Medical College were reviewed. The LNR, or node ratio (Nr) was defined as the ratio of metastatic LNs ompared to the total number of resected LNs. Overall survival between groups was compared with the log-rank test. The cutoff point of LNR was established by grouping patients with 10% increment in Nr, and then combining the neighborhood survival curves using the log-rank test. A new TNrM staging system, was constructed by replacing the American Joint Committee on Cancer (AJCC) N categories with the Nr categories in the new TNM staging system. The time-dependent receiver operating characteristic curves were used to evaluate the predictive performance of the seventh edition AJCC staging system and the TNrM staging system.
RESULTS: The median number of resected LNs was 12 (range: 4-44), and 25% and 75% interquartile rangeswere8 and 16. Patients were classified into four Nr categories with distinctive survival differences (Nr0: LNR = 0; Nr1: 0% < LNR ≤ 10%; Nr2: 10% < LNR ≤ 20%; and Nr3: LNR > 20%). From N categories to Nr categories, 557 patients changed their LN stage. The median survival time (MST) for the four Nr categories (Nr0-Nr3) was 155.0 mo, 39.0 mo, 28.0 mo, and 19.0 mo, respectively, and the 5-year overall survival was 61.1%, 41.1%, 33.0%, and 22.9%, respectively (P < 0.001). Overall survival was significantly different for the AJCC N categories when patients were subgrouped into 15 or more vs fewer than 15 examined nodes, except for the N3 category (P = 0.292). However, overall survival was similar when the patients in all four Nr categories were subgrouped into 15 or more vs fewer than 15 nodes. Using the time-dependent receiver operating characteristic, we found that the Nr category and TNrM stage had higher accuracy in predicting survival than the AJCC N category and TNM stage.
CONCLUSION: A staging system based on LNR may have better prognostic stratification of patients with ESCC than the current TNM system, especially for those undergoing limited lymphadenectomy.
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The characteristics of oesophageal squamous cell carcinoma: an analysis of 1317 cases in southeastern China. Contemp Oncol (Pozn) 2015; 19:137-41. [PMID: 26034392 PMCID: PMC4444447 DOI: 10.5114/wo.2015.51419] [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] [Received: 09/06/2013] [Revised: 10/24/2013] [Accepted: 11/14/2013] [Indexed: 12/11/2022] Open
Abstract
AIM OF THE STUDY To research the demographic and histopathological features of ESCC in southeastern China. MATERIAL AND METHODS We retrospectively reviewed the ESCC cases in the biobank of the National Engineering Centre for Biochip in Shanghai, which cooperates with lots of hospitals and research institutions in southeastern China. The patients were pathologically confirmed as having ESCC. The demographic and histopathological features of these cases were analysed subsequently. RESULTS A total of 1317 patients were enrolled. The overall male: female ratio was 2.88: 1. 74.34% of these cases occurred in people aged between 50-70 years. Dysphagia was the most common symptom, which accounted for 93.40% of all the patients. Stage II and III were predominant (79.73%). 72.89% of patients had a tumour length greater than 3 cm. Most of the tumours (65.83%) were located in middle third of the oesophagus. There was a significant difference among the tumour stage, length, and location in different sex groups (P < 0.05), but not between different age groups (P > 0.05). In males, ESCC is usually located in the lower parts, with a longer tumour length and higher tumour stage. 24.15% of patients had lymph nodes ratio (LNR) > 0.2. CONCLUSIONS In our analysis, dysphagia was more common in ESCC patients, to whom more attention should be paid. Additionally, males had a higher incidence, with longer and more distant disease, which gives a poor prognosis.
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Lin CS, Cheng CT, Liu CY, Lee MY, Hsiao MC, Shih CH, Liu CC. Radical Lymph Node Dissection in Primary Esophagectomy for Esophageal Squamous Cell Carcinoma. Ann Thorac Surg 2015; 100:278-86. [PMID: 26002444 DOI: 10.1016/j.athoracsur.2015.02.053] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2014] [Revised: 02/16/2015] [Accepted: 02/18/2015] [Indexed: 12/13/2022]
Abstract
BACKGROUND Subtotal esophagectomy with radical lymph node dissection (RLND) remains an effective therapeutic strategy for localized esophageal squamous cell carcinoma (ESCC). However, controversy exists regarding the extent to which RLND should be performed. We reappraised the prognostic impact and accurate nodal staging of RLND in ESCC. METHODS The data from 101 ESCC patients (mean age, 57.5 years; 93 men) who underwent primary subtotal esophagectomy were retrospectively collected. Candidate variables, including the number of total dissected lymph nodes (TDLN [subgrouped into TDLN less than 13, TDLN 13 to 40, and TDLN more than 40]), were evaluated to determine their prognostic impacts and hazard ratio (HR). RESULTS Fewer TDLN (p < 0.001; HR 9.011, 2.449, and 1.000 for TDLN less than 13, TDLN 13 to 40, and TDLN more than 40, respectively), tumor length exceeding 3.5 cm (p < 0.001; HR 3.321), resection margin invasion (p < 0.001; HR 14.493), and positive nodal status (p = 0.002; HR 2.730) were independent predictors of a poor prognosis. Considering the 54 node-negative patients, more TDLN correlated with improved survival (p = 0.001). Risk analysis demonstrated that one fewer TDLN could contribute to an increased HR of 1.047 (p = 0.014). However, RLND involving more TDLN appeared to lose the prognostic impact for the 47 node-positive patients (p = 0.072). Furthermore, the number of positive dissected lymph nodes remained at approximately 4 if the number of TDLN exceeded 20. CONCLUSIONS For N-negative or N-positive ESCC patients undergoing primary surgical resection, the number of TDLN influenced their prognosis or nodal staging accuracy, respectively. At least 20 TDLN were necessary for N-positive patients.
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Affiliation(s)
- Chen-Sung Lin
- Faculty of Medicine, National Yang-Ming University, Taipei, Taiwan; Division of Thoracic Surgery, Taipei Hospital, Ministry of Health and Welfare, New Taipei City, Taiwan; Division of Thoracic Surgery, Koo-Foundation Sun Yat-sen Cancer Center, Taipei, Taiwan
| | - Chih-Tao Cheng
- National Defense University, Taipei, Taiwan; Division of Psychiatry, Koo-Foundation Sun Yat-sen Cancer Center, Taipei, Taiwan
| | - Chao-Yu Liu
- Faculty of Medicine, National Yang-Ming University, Taipei, Taiwan; Division of Thoracic Surgery, Far Eastern Memorial Hospital, New Taipei City, Taiwan; Division of Thoracic Surgery, Koo-Foundation Sun Yat-sen Cancer Center, Taipei, Taiwan
| | - Ming-Yuan Lee
- Faculty of Medicine, National Yang-Ming University, Taipei, Taiwan; Department of Pathology, Koo-Foundation Sun Yat-sen Cancer Center, Taipei, Taiwan
| | - Mu-Chi Hsiao
- Division of Thoracic Surgery, Taipei Hospital, Ministry of Health and Welfare, New Taipei City, Taiwan; Division of Thoracic Surgery, Koo-Foundation Sun Yat-sen Cancer Center, Taipei, Taiwan
| | - Chih-Hsun Shih
- Faculty of Medicine, National Yang-Ming University, Taipei, Taiwan; Division of Thoracic Surgery, Koo-Foundation Sun Yat-sen Cancer Center, Taipei, Taiwan.
| | - Chia-Chuan Liu
- Faculty of Medicine, National Yang-Ming University, Taipei, Taiwan; Division of Thoracic Surgery, Koo-Foundation Sun Yat-sen Cancer Center, Taipei, Taiwan
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de Burlet KJ, van den Hout MFCM, Putter H, Smit VTHBM, Hartgrink HH. Total number of lymph nodes in oncologic resections, is there more to be found? J Gastrointest Surg 2015; 19:943-8. [PMID: 25691110 PMCID: PMC4412279 DOI: 10.1007/s11605-015-2764-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2014] [Accepted: 01/26/2015] [Indexed: 01/31/2023]
Abstract
Pathologic staging of oncologic specimens includes the identification of the accurate lymph node status. Retrieving more lymph nodes leads to a more reliable N0 status in the TNM classification. The aim of this prospective study was to evaluate whether more lymph nodes can be retrieved from oncologic resection specimens when more time is invested in the search and if this contributes to a more reliable N-status in the individual patient. A total of 67 gastrointestinal oncologic specimens were reexamined for additional lymph nodes. The mean number of lymph nodes collected in the prospective group was compared against two retrospective groups, one before minima for lymph node counts were set (retrospective group 1) and one after (retrospective group 2). More lymph nodes were dissected per specimen in the prospective group (24.1 lymph nodes), compared to the retrospective group (14.3 lymph nodes, P = <0.001). During the study period, more patients were diagnosed as pN+ compared to the two retrospective groups (62.7 vs. 47.8 % respectively, P = 0.082). Significantly more lymph nodes can be found in oncologic specimens when more time is invested in the search. This will result in more accurate staging of the tumor.
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Affiliation(s)
- Kirsten J de Burlet
- Department of Surgery, K6-50, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands,
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Prophylactic thoracic duct ligation has unfavorable impact on overall survival in patients with resectable oesophageal cancer. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2014; 40:1756-62. [DOI: 10.1016/j.ejso.2014.05.002] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2014] [Revised: 04/06/2014] [Accepted: 05/08/2014] [Indexed: 11/16/2022]
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Ravishankaran P, Krishnamurthy A. Prognostic value of metastatic lymph nodal ratio in squamous cell carcinoma of esophagus: A three-step extrapolative study. South Asian J Cancer 2014; 3:213-6. [PMID: 25422807 PMCID: PMC4236699 DOI: 10.4103/2278-330x.142976] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
Background: Transthoracic esophagectomy (TTE) and transhiatal esophagectomy (THE) are the two most common surgical approaches for carcinoma esophagus. Several studies have shown lymph nodal involvement to be one of the most important prognostic factors in carcinoma esophagus. Aims: The primary objective of this study was to explore the effectiveness of the ratio of positive lymph nodes to excised lymph nodes, namely the metastatic lymph nodal ratio (MLNR) as a prognostic factor in the survival of patients with carcinoma esophagus. Settings and Design: Retrospective analysis of a prospective database. Materials and Methods: A review of the operated esophageal cancer patients treated at a tertiary cancer center in South India between January 2002 and December 2006. Statistical analysis was done with the help of SPSS version 17 software (SPSS Inc., Chicago, IL). Proportions were compared using the Chi-square test. Survival data was generated using life table methods. Differences in survival estimates were compared using log-rank test. Results and Conclusions: Our study emphatically showed that the survival outcomes of patients with squamous cell carcinoma of the esophagus can be discriminated based on the MLNR groups, and it can be a reliable prognostic indicator. The overall survival for patients undergoing TTE, or THE for the entire cohort of patients was however not statistically significant. Whether a more aggressive TTE is a better esophageal cancer operation or whether MLNR is the factor that can significantly impact survival regardless of the technique is an issue that would require further investigation.
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Affiliation(s)
- Praveen Ravishankaran
- Departments of Surgical Oncology, Cancer Institute, Adyar, Chennai, Tamil Nadu, India
| | - Arvind Krishnamurthy
- Departments of Surgical Oncology, Cancer Institute, Adyar, Chennai, Tamil Nadu, India
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Wu SG, Li FY, Zhou J, Lin Q, Sun JY, Lin HX, Guan XX, He ZY. Prognostic value of different lymph node staging methods in esophageal squamous cell carcinoma after esophagectomy. Ann Thorac Surg 2014; 99:284-90. [PMID: 25440270 DOI: 10.1016/j.athoracsur.2014.08.036] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2014] [Revised: 08/19/2014] [Accepted: 08/25/2014] [Indexed: 12/13/2022]
Abstract
BACKGROUND This study aimed to investigate the prognostic value of number of involved lymph nodes, number of removed lymph nodes, ratio of involved to removed nodes (lymph node ratio), and number of negative lymph nodes in esophageal squamous cell carcinoma (ESCC) patients after esophagectomy. METHODS A retrospective review of 603 patients receiving esophagectomy for ESCC was made. Cox regression analysis was performed to identify significant prognostic factors. RESULTS The median follow-up time was 36.7 months, and the 5-year overall survival (OS) was 43.5%. Patients with negative lymph node count ≥ 14 had better survival (p < 0.001). Univariate Cox analysis showed that the number of involved lymph nodes, number of removed lymph nodes, lymph node ratio, and number of negative lymph nodes influenced OS (p < 0.05 for all). Multivariate Cox analysis indicated that the number of involved lymph nodes and number of negative lymph nodes were independent prognostic factors for OS, and a higher number of negative lymph nodes was associated with lower mortality. The number of removed lymph nodes and lymph node ratio had no significant effect on OS. The number of negative lymph nodes had prognostic value in different lymph node stages and in two-field or three-field lymphadenectomy. CONCLUSIONS For ESCC patients after esophagectomy, the number of involved lymph nodes and the number of negative lymph nodes had a better prognostic value than did the number of removed lymph nodes and lymph node ratio.
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Affiliation(s)
- San-Gang Wu
- Department of Radiation Oncology, Xiamen Cancer Center, the First Affiliated Hospital of Xiamen University, Xiamen, People's Republic of China
| | - Feng-Yan Li
- Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Department of Radiation Oncology, Collaborative Innovation Center of Cancer Medicine, Guangzhou, People's Republic of China
| | - Juan Zhou
- Department of Obstetrics and Gynecology, Xiamen Cancer Center, the First Affiliated Hospital of Xiamen University, Xiamen, People's Republic of China
| | - Qin Lin
- Department of Radiation Oncology, Xiamen Cancer Center, the First Affiliated Hospital of Xiamen University, Xiamen, People's Republic of China
| | - Jia-Yuan Sun
- Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Department of Radiation Oncology, Collaborative Innovation Center of Cancer Medicine, Guangzhou, People's Republic of China
| | - Huan-Xin Lin
- Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Department of Radiation Oncology, Collaborative Innovation Center of Cancer Medicine, Guangzhou, People's Republic of China
| | - Xun-Xing Guan
- Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Department of Radiation Oncology, Collaborative Innovation Center of Cancer Medicine, Guangzhou, People's Republic of China
| | - Zhen-Yu He
- Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Department of Radiation Oncology, Collaborative Innovation Center of Cancer Medicine, Guangzhou, People's Republic of China.
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Cho JW, Choi SC, Jang JY, Shin SK, Choi KD, Lee JH, Kim SG, Sung JK, Jeon SW, Choi IJ, Kim GH, Jee SR, Lee WS, Jung HY. Lymph Node Metastases in Esophageal Carcinoma: An Endoscopist's View. Clin Endosc 2014; 47:523-9. [PMID: 25505718 PMCID: PMC4260100 DOI: 10.5946/ce.2014.47.6.523] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2013] [Revised: 08/28/2013] [Accepted: 10/05/2013] [Indexed: 12/23/2022] Open
Abstract
One of the most important prognostic factors in esophageal carcinoma is lymph node metastasis, and in particular, the number of affected lymph nodes, which influences long-term outcomes. The esophageal lymphatic system is connected longitudinally and transversally; thus, the pattern of lymph node metastases is very complex. Early esophageal cancer frequently exhibits skipped metastasis, and minimal surgery using sentinel node navigation cannot be performed. In Korea, most esophageal cancer cases are squamous cell carcinoma (SCC), although the incidence of adenocarcinoma has started to increase recently. Most previous reports have failed to differentiate between SCC and adenocarcinoma, despite the fact that the Union for International Cancer Control (7th edition) and American Joint Committee on Cancer staging systems both consider these separately because they differ in cause, biology, lymph node metastasis, and outcome. Endoscopic tumor resection is an effective and safe treatment for lesions with no associated lymph node metastasis. Esophageal mucosal cancer confined to the lamina propria is an absolute indication for endoscopic resection, and a lesion that has invaded the muscularis mucosae can be cured by local resection if invasion to the lymphatic system has not occurred.
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Affiliation(s)
- Jin Woong Cho
- Department of Internal Medicine, Presbyterian Medical Center, Jeonju, Korea
| | - Suck Chei Choi
- Department of Internal Medicine, Digestive Disease Research Institute, Wonkwang University School of Medicine, Iksan, Korea
| | - Jae Young Jang
- Division of Gastroenterology, Department of Internal Medicine, Kyung Hee University School of Medicine, Seoul, Korea
| | - Sung Kwan Shin
- Division of Gastroenterology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Kee Don Choi
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jun Haeng Lee
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Sang Gyun Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Jae Kyu Sung
- Department of Internal Medicine, Chungnam National University School of Medicine, Daejeon, Korea
| | - Seong Woo Jeon
- Department of Internal Medicine, Kyungpook National University School of Medicine, Daegu, Korea
| | - Il Ju Choi
- Center for Gastric Cancer, National Cancer Center, Goyang, Korea
| | - Gwang Ha Kim
- Department of Internal Medicine, Pusan National University School of Medicine, Busan, Korea
| | - Sam Ryong Jee
- Department of Internal Medicine, Inje University Busan Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Wan Sik Lee
- Division of Gastroenterology, Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea
| | - Hwoon-Yong Jung
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Issaka A, Ermerak NO, Bilgi Z, Kara VH, Celikel CA, Batirel HF. Preoperative Chemoradiation Therapy Decreases the Number of Lymph Nodes Resected During Esophagectomy. World J Surg 2014; 39:721-6. [DOI: 10.1007/s00268-014-2847-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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Hou X, Gu YK, Liu XW, Fu JH, Wang X, Zhang LJ, Luo RZ, Lin P, Yang HX. The impact of tumor cell differentiation on survival of patients with resectable esophageal squamous cell carcinomas. Ann Surg Oncol 2014; 22:1008-14. [PMID: 25201504 DOI: 10.1245/s10434-014-4067-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2014] [Indexed: 12/31/2022]
Abstract
BACKGROUND The current American Joint Committee on Cancer staging system considers tumor cell differentiation grade to be a factor in the staging of esophageal squamous cell carcinoma (ESCC) in pathologic T0-3N0M0 cases. However, more data are essential to test its efficacy. We sought to investigate the tumor-node-metastasis categories for which tumor cell grade might affect overall survival in Chinese patients. METHODS We conducted a retrospective review of 1,220 patients with ESCC who underwent complete resection between December 1996 and December 2008. Survival was calculated by the Kaplan-Meier method, and the log-rank test was used to assess differences in survival between groups. Subgroup analyses and the Cox proportional hazards model were used to further determine the effect of tumor cell grade on overall survival. RESULTS The 5-year survival rates for the G1, G2, and G3 groups of pathologic T2N0M0 ESCC cases were 80.1, 61.9, and 47.4%, respectively (p = 0.015), and these rates in the pathologic T3N0M0 ESCC cases were 66.7, 61.7, and 41.2%, respectively (p = 0.020). However, the differences in the survival of the different tumor cell grade groups of the pathologic T1N0M0 (p = 0.198) and the node positive categories (p = 0.063) were not statistically significant. Multivariate Cox regression analysis confirmed that tumor cell grade independently affected the overall survival of patients with pathologic T2-3N0M0 ESCC. CONCLUSIONS The staging of ESCC in the Chinese population should be simplified by omitting tumor cell grade as a variable in patients with pathologic T1N0M0 disease. More data are needed to verify our results.
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Affiliation(s)
- Xue Hou
- Department of Medical Oncology, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, People's Republic of China
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Lu J, Tao H, Song D, Chen C. Recurrence risk model for esophageal cancer after radical surgery. Chin J Cancer Res 2013; 25:549-55. [PMID: 24255579 DOI: 10.3978/j.issn.1000-9604.2013.10.05] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2012] [Accepted: 11/22/2012] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVE The aim of the present study was to construct a risk assessment model which was tested by disease-free survival (DFS) of esophageal cancer after radical surgery. METHODS A total of 164 consecutive esophageal cancer patients who had undergone radical surgery between January 2005 and December 2006 were retrospectively analyzed. The cutpoint of value at risk (VaR) was inferred by stem-and-leaf plot, as well as by independent-samples t-test for recurrence-free time, further confirmed by crosstab chi-square test, univariate analysis and Cox regression analysis for DFS. RESULTS The cutpoint of VaR was 0.3 on the basis of our model. The rate of recurrence was 30.3% (30/99) and 52.3% (34/65) in VaR <0.3 and VaR ≥0.3 (chi-square test, (χ) (2) =7.984, P=0.005), respectively. The 1-, 3-, and 5-year DFS of esophageal cancer after radical surgery was 70.4%, 48.7%, and 45.3%, respectively in VaR ≥0.3, whereas 91.5%, 75.8%, and 67.3%, respectively in VaR <0.3 (Log-rank test, (χ) (2) =9.59, P=0.0020), and further confirmed by Cox regression analysis [hazard ratio =2.10, 95% confidence interval (CI): 1.2649-3.4751; P=0.0041]. CONCLUSIONS The model could be applied for integrated assessment of recurrence risk after radical surgery for esophageal cancer.
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Affiliation(s)
- Jincheng Lu
- Department of Radiotherapy, Jiangsu Cancer Hospital, Nanjing 210009, China
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Use of the metastatic lymph node ratio to evaluate the prognosis of esophageal cancer patients with node metastasis following radical esophagectomy. PLoS One 2013; 8:e73446. [PMID: 24039944 PMCID: PMC3767826 DOI: 10.1371/journal.pone.0073446] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2013] [Accepted: 07/22/2013] [Indexed: 12/26/2022] Open
Abstract
Objectives The objective of this study was to investigate the number of metastatic lymph nodes (pN) and the metastatic lymph node ratio (MLR) on the post-surgical prognosis of Chinese patients with esophageal cancer (EC) and lymph node metastasis. Methods We enrolled 353 patients who received primary curative resection for EC from 1990 to 2003. The association of pN and MLR with 5-year overall survival (OS) was examined by receiver operating characteristic (ROC) and area under the curve (AUC) analysis. The Kaplan-Meier method was used to calculate survival rates, and survival curves were compared with the log-rank test. The Cox model was employed for univariate and multivariate analyses of factors associated with 5-year OS. Results The median follow-up time was 41 months, and the 1-, 3- and 5-year OS rates were 71.2%, 30.4%, and 19.5%, respectively. Univariate analysis showed that age, pN stage, and the MLR were prognostic factors for OS. Patients with MLRs less than 0.15, MLRs of 0.15-0.30, and MLRs greater than 0.30 had 5-year OS rates of 30.1%, 17.8%, and 9.5%, respectively (p < 0.001). Patients classified as pN1, pN2, and pN3 had 5-year OS rates of 23.7%, 11.4%, and 9.9%, respectively (p < 0.001). Multivariate analysis indicated that a high MLR and advanced age were significant and independent risk factors for poor OS. Patients classified as pN2 had significantly worse OS than those classified as pN1 (p = 0.022), but those classified as pN3 had similar OS as those classified as pN1 (p = 0.166). ROC analysis indicated that MLR (AUC = 0.585, p = 0.016) had better predictive value than pN (AUC = 0.565, p = 0.068). Conclusions The integrated use of MLR and pN may be suitable for evaluation of OS in Chinese patients with EC and positive nodal metastasis after curative resection.
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Wong J, Weber J, Almhanna K, Hoffe S, Shridhar R, Karl R, Meredith KL. Extent of lymphadenectomy does not predict survival in patients treated with primary esophagectomy. J Gastrointest Surg 2013; 17:1562-8; discussion 1569. [PMID: 23818125 DOI: 10.1007/s11605-013-2259-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2012] [Accepted: 06/11/2013] [Indexed: 01/31/2023]
Abstract
BACKGROUND The number of lymph nodes resected and its impact on survival for patients with esophageal cancer remains undefined. Current guidelines recommend extended lymphadenectomy in patients not receiving neoadjuvant therapy. We reviewed our single institutional experience with nodal harvest for esophageal cancer in a non-neoadjuvant therapy setting. METHODS Patients who underwent esophagectomy as primary therapy were indentified from a prospectively maintained database consisting of 704 patients who underwent esophagectomy. Patients were stratified by number of lymph nodes (LN) resected: >5, 10, 12, 15, or 20. Survival, clinical, and pathologic parameters were analyzed with Kaplan-Meier curves, chi-square, or Fisher's exact tests where appropriate. RESULTS We identified 246 patients who underwent esophagectomy as initial treatment. The mean age was 65 ±10 years. The majority of patients were male (87%). Ivor-Lewis esophagectomy was performed for 71%, minimally invasive esophagectomy for 15%, transhiatal esophagectomy for 12%, and three-field esophagectomy for 2%. At 60 months follow-up, there was no statistically significant difference in overall survival (OS) or disease-free survival (DFS) between patients with < vs. >5 LN resected (p = 0.74 and p = 0.67, respectively) or in the < vs. >10 (p = 0.33, p = 0.11), 12 (p = 0.82, p = 0.90), 15 (p = 0.45, p = 0.79), or 20 (p = 0.72, p = 0.86) resected LN groups. Patients were then subdivided into node-positive and node-negative cohorts and stratified by nodal harvest. In the subgroups of patients with node-negative and node-positive disease, OS and DFS also did not significantly differ between groups with respect to number of nodes resected (p > 0.05). A total of 49 (20%) patients developed recurrent disease; however, recurrence was not statistically associated with number of LN resected (p > 0.05). CONCLUSION We found no impact of extent of lymphadenectomy on overall or disease-free survival in patients treated with esophagectomy without neoadjuvant therapy. In addition, the number of nodes resected at esophagectomy did not affect recurrence rates. Current recommendations for increased nodal resection during esophagectomy in patients not receiving neoadjuvant therapy may not improve patient outcomes, and this phenomenon warrants further investigation.
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Affiliation(s)
- Joyce Wong
- Department of Gastrointestinal Surgery, H. Lee Moffitt Cancer Center, Tampa, FL, USA.
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Abstract
BACKGROUND Several researchers have determined the tumor length to be an important prognostic indictor of esophageal cancer (EC). However, controversy exists concerning the optimal cut-off points for tumor length to predict overall survival. The aim of this study was to determine the prognostic value of tumor length and propose the optimum cut-off point for tumor length in predicting survival difference in elderly patients with esophageal squamous cell carcinoma (ESCC). METHODS From January 2001 to December 2009, a retrospective analysis of 132 consecutive patients older than 70 years with ESCC was conducted. A receiver-operating characteristic (ROC) curve for survival prediction was plotted to verify the optimum cut-off point for tumor length. Univariate and multivariate analyses were performed to evaluate prognostic parameters for survival. RESULTS A ROC curve for survival prediction was plotted to verify the optimum cut-off point for tumor length, which was 4.0 cm. Patients with tumor length ≤ 4.0 cm had significantly better 5-year survival rate than patients with a tumor length >4.0 cm (60.7% versus 31.6%, P = 0.007). Multivariate analyses showed that tumor length (>4.0 cm versus ≤ 4.0 cm, P = 0.036), differentiation (poor versus well/moderate, P = 0.032), N staging (N1-3 versus N0, P = 0.018), and T grade (T3-4 versus T1-2, P = 0.002) were independent prognostic factors. CONCLUSION Tumor length is a predictive factor for long-term survival in elderly patients with ESCC, especially in T3-4 grade or nodal-negative patients. We conclude that 4.0 cm may be the optimum cut-off point for tumor length in predicting survival in elderly patients with ESCC.
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Affiliation(s)
- Ji-Feng Feng
- Department of Thoracic Surgery, Zhejiang Cancer Hospital, No. 38 Guangji Road, Banshan Bridge, Hangzhou 310022, China
- Key Laboratory Diagnosis and Treatment Technology on Thoracic Oncology, Zhejiang Province, Hangzhou 310022, China
| | - Ying Huang
- Department of Nursing, Zhejiang Cancer Hospital, Hangzhou 310022, China
| | - Qiang Zhao
- Department of Thoracic Surgery, Zhejiang Cancer Hospital, No. 38 Guangji Road, Banshan Bridge, Hangzhou 310022, China
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Feng JF, Huang Y, Chen L, Zhao Q. Prognostic analysis of esophageal cancer in elderly patients: metastatic lymph node ratio versus 2010 AJCC classification by lymph nodes. World J Surg Oncol 2013; 11:162. [PMID: 23866060 PMCID: PMC3729418 DOI: 10.1186/1477-7819-11-162] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2012] [Accepted: 07/08/2013] [Indexed: 02/07/2023] Open
Abstract
Background Recent studies have proposed a new prognostic factor (metastatic lymph node ratio, or MLNR) for patients with esophageal cancer (EC). However, to the best of our knowledge, there have been no studies conducted to date regarding MLNR in elderly patients. The aim of this study was to determine the prognostic value of MLNR staging compared with the 2010 American Joint Committee on Cancer (AJCC) N staging in elderly patients with EC. Methods From January 2001 to December 2009, a retrospective analysis of 132 consecutive patients older than 70 years of age with esophageal squamous cell carcinoma (ESCC) was conducted. Prognostic factors for disease-specific survival were analyzed. Receiver operating characteristic curves were also plotted to verify the accuracy of MLNR staging and N staging for survival prediction. Results The disease-specific survival rates of N0, N1, N2 and N3 patients according to the AJCC Cancer Staging Manual Seventh Edition N staging were 65.5%, 42.9%, 22.2% and 0, respectively (N0 vs N1, P = 0.017; N1 vsN2, = 0.050; N2 vs N3, P < 0.001). The disease-specific survival rates of MLNR0, MLNR1, MLNR2 and MLNR3 patients were 65.5%, 45.0%, 21.1% and 0, respectively (MLNR0 vsMLNR1, P = 0.026; MLNR1 vs MLNR2, P = 0.033; MLNR2 vs MLNR3, P = 0.015). The areas under the curve were 0.731 for the 2010 AJCC N staging and 0.737 for the MLNR staging. Conclusion MLNR is an independent predictor of survival in elderly patients with ESCC. MLNR staging predicts survival after EC similarly to the 2010 AJCC N classifications and should be considered an alternative to current N staging.
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Akutsu Y, Matsubara H. Lymph node dissection for esophageal cancer. Gen Thorac Cardiovasc Surg 2013; 61:397-401. [PMID: 23529259 DOI: 10.1007/s11748-013-0237-1] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2013] [Indexed: 12/26/2022]
Abstract
The prevalence of lymph node (LN) metastasis in esophageal cancer (EC) is widely spread to all three fields, namely, to the neck region, the mediastinal region and the abdominal region. Furthermore, the status of LN metastasis has been recognized as a key factor that influences the outcome after EC surgery. Therefore, the latest version of the UICC/AJCC TNM classification (7th edition) applied the number of metastatic LNs as an N factor. However, the precise clinical diagnosis of metastatic LNs is still difficult. This is mainly because there are many micrometastases in EC. Therefore, the Japanese Classification of Esophageal Cancer (10th edition) has not incorporated the number of LN metastases into the N factor for its staging system and the accurate preoperative diagnosis of LN status is currently one of the most important issues to be resolved for EC. Given the frequency and extent of LN metastasis and its significance for the survival, controlling LN metastasis is a rational therapeutic strategy, and an extended LN dissection, such as three-field lymph node dissection may be logical, although appropriate patient selection is necessary. On the other hand, recent arguments have supported a reduction of unnecessary LN dissection in esophagectomy. To curtail unnecessary LN dissection, one of the current topics is sentinel lymph node-guided surgery and is being investigated as part of the next generation surgeries for EC. In this article, recent literatures were reviewed and we discuss the current status of lymph node dissection in EC.
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Affiliation(s)
- Yasunori Akutsu
- Department of Frontier Surgery, Graduate School of Medicine, Chiba University, 1-8-1, Inohana, Chuo-ku, Chiba 260-8670, Japan.
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Liu Q, Tan Z, Lin P, Long H, Zhang L, Rong T, Meng Y, Ma G. Impact of the number of resected lymph nodes on postoperative survival of patients with node-negative oesophageal squamous cell carcinoma. Eur J Cardiothorac Surg 2013; 44:631-6. [PMID: 23477926 DOI: 10.1093/ejcts/ezt097] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
OBJECTIVES Research on the number of resected lymph nodes (LNs) in the cases of node-negative oesophageal squamous cell carcinoma (ESCC) is inadequate. This study was designed to analyse the prognostic impact of the number of resected LNs on node-negative ESCC. METHODS Node-negative ESCC patients (n = 666) who underwent oesophagectomy between January 1990 and December 2005 were classified into three groups according to the number of LNs resected during surgery (≤8, 9-15 and ≥16). Kaplan-Meier curves and stratified analyses according to the American Joint Committee on Cancer staging were used to compare oesophageal cancer-specific survival (CSS). Cox regression and stratified analyses were used to identify the independent prognostic factors related to postoperative survival. RESULTS CSS rates increased with the number of negative resected LNs (P < 0.01). Three- and 5-year survival rates were 67.8 and 59.8%, respectively, for patients with ≥16 resected LNs, 64.8 and 53.8%, respectively, for patients with 9-15 resected LNs and 55.3 and 43.6%, respectively, for patients with ≤8 resected LNs. Multivariate analysis showed that the number of resected nodes [P < 0.01, relative risk (RR) = 1.0, 95% confidence interval (CI) 1.0-1.0] was an independent factor for CSS among node-negative ESCC patients. Further stratified analysis revealed that the number of resected LNs was an independent factor for survival in Stage IIA ESCC patients (P < 0.01, RR = 0.9, 95% CI 0.9-1.0). CONCLUSIONS The number of resected LNs is an independent prognostic factor for the survival of node-negative ESCC patients. The minimum resection number recommended for accurate staging is 16.
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Affiliation(s)
- Qianwen Liu
- Department of Thoracic Surgery, Cancer Center, Sun Yat-sen University, State Key Laboratory of Oncology in South China, Guangzhou, China
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Li Q, Wu SG, Gao JM, Xu JJ, Hu LY, Xu T. Impact of esophageal cancer staging on overall survival and disease-free survival based on the 2010 AJCC classification by lymph nodes. JOURNAL OF RADIATION RESEARCH 2013; 54:307-314. [PMID: 23124992 PMCID: PMC3589934 DOI: 10.1093/jrr/rrs096] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/02/2012] [Revised: 09/26/2012] [Accepted: 09/26/2012] [Indexed: 06/01/2023]
Abstract
This retrospective study investigated the effect of modifications presented in the seventh edition of the American Joint Committee on Cancer (AJCC) Manual for staging esophageal cancer on the characterization of the effectiveness of post-operative chemotherapy and/or radiotherapy, as measured by overall and disease-free survival. The seventh edition of the AJCC Manual classifies the number of lymph nodes (N) positive for regional metastasis into three subclasses. We used the AJCC classification system to characterize the cancers of 413 Chinese patients with esophageal cancer who underwent radical resection plus regional lymph node dissection over a 10-year period. The 10-year survival rate was 14.3% for stage N1 patients and 6.1% for stage N2 patients. Only one stage N3 patient was followed >4 years (53.4 months). The 10-year disease-free rate was 13.6% for stage N1 patients. Patients with stage N2 or N3 cancer were more likely to have tumor recurrences, metastases or death than patients with stage N1 cancer. Post-operative radiotherapy provided no survival benefit, and may have had a negative effect on survival. In this study, the N stage of esophageal cancer was an independent factor affecting overall and disease-free survival. Our results did not clarify whether or not radiotherapy after radical esophagectomy offers any survival benefit to patients with esophageal cancer.
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Affiliation(s)
- Qun Li
- State Key Laboratory for Cancer Research in Southern China, Guangzhou 510060, Guangdong, People's Republic of China.
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Wu N, Chen Z, Pang L, Ma Q, Chen G. Prognostic significance of lymph node characteristics on survival in esophageal squamous cell carcinomas. Wien Klin Wochenschr 2013; 125:26-33. [PMID: 23292643 DOI: 10.1007/s00508-012-0310-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2012] [Accepted: 11/29/2012] [Indexed: 12/14/2022]
Abstract
OBJECTIVES To investigate the prognostic significance of lymph node characteristics (total number of resected lymph nodes, metastatic lymph node ratio, and metastatic lymph nodes site) on survival in patients with esophageal squamous cell carcinoma. METHODS Patients who underwent esophagectomy at Huashan Hospital, Fudan University, between October 1, 2003, and December 31, 2008, were reviewed. Survival data and clinicopathological characteristics were collected. RESULTS Among 205 patients, the median overall survival time was 48.0 months and the overall 5-year survival rate was 44.7 %. The independent risk factors for disease-free survival were the metastatic lymph node ratio (P < 0.001) and the number of positive lymph nodes (P < 0.001) and not the total number of resected lymph nodes (Χ (2) = 3.063, P = 0.216). There was no difference in survival between patients with extrathoracic and intrathoracic lymph node metastasis (Χ (2) = 0.295, P = 0.587). No significant relation was found between tumor location and the site of metastatic lymph nodes (rs = 0.125, P = 0.245). CONCLUSIONS Our finding revealed that the ratio and the number, but not the site, of metastatic lymph nodes were independent prognostic risk factors in esophageal squamous cell carcinomas. We suggest taking these factors into consideration for better estimation of prognosis.
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Affiliation(s)
- Ning Wu
- Department of Cardiothoracic Surgery, Huashan Hospital of Fudan University, 200040 Shanghai, PR China
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Hou X, Wei JC, Xu Y, Luo RZ, Fu JH, Zhang LJ, Lin P, Yang HX. The positive lymph node ratio predicts long-term survival in patients with operable thoracic esophageal squamous cell carcinoma in China. Ann Surg Oncol 2012; 20:1653-9. [PMID: 23247981 DOI: 10.1245/s10434-012-2794-4] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2012] [Indexed: 12/12/2022]
Abstract
BACKGROUND Controversy exists concerning the optimal cutoff points for the positive lymph node ratio (PLNR) to predict overall survival. We aim to propose reasonable PLNR categories for the discrimination of the survival difference between groups. METHODS We used data from two centers to establish a training (n = 1006) and a validation (n = 783) cohort. All of the patients underwent curative surgical treatment. Martingale residuals from a Cox proportional hazards regression model were used to determine the optimal cutoff points for PLNR to predict overall survival. The survival rate was calculated using the Kaplan-Meier method, and a log-rank test was used to assess the survival differences between groups. The results obtained from the training cohort were tested with the validation cohort at each step. RESULTS We classified the patients into four revised nodal categories: R-pN0 (PLNR = 0), R-pN1 (0< PLNR ≤0.1), R-pN2 (0.1< PLNR ≤0.3), and R-pN3 (PLNR >0.3). Subgroup analysis for the pT2 and pT3 cases showed that the survival differences could be well discriminated between groups based on PLNR in both the training cohort and validation cohort. When we modified the current staging system using revised nodal categories (based on PLNR) instead of the AJCC nodal categories, the survival rate could also be easily distinguished between patients in different stages in both cohorts of patients. CONCLUSIONS The survival rate of ESCC can be discriminated between four groups: PLNR = 0, 0< PLNR ≤0.1, 0.1< PLNR ≤0.3, and PLNR >0.3. Further studies are required to confirm these results.
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Affiliation(s)
- Xue Hou
- Department of Medical Oncology, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, People's Republic of China
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Song Z, Wang J, Lin B, Zhang Y. Analysis of the tumor length and other prognosis factors in pT1-2 node-negative esophageal squamous cell carcinoma in a Chinese population. World J Surg Oncol 2012; 10:273. [PMID: 23249675 PMCID: PMC3560067 DOI: 10.1186/1477-7819-10-273] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2012] [Accepted: 11/24/2012] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Tumor length is an important prognostic factor for many carcinomas, but its role in esophageal cancer remained undetermined. The aim of this study was to investigate the effect of tumor length on survival for patients with confined tumors (grade pT1-2) without lymph-node metastases in esophageal squamous cell carcinoma. METHODS We enrolled 201 patients with esophageal squamous cell carcinoma (SCC) who had undergone surgical resection and been confirmed as pT1-2N0M0. The relationship of tumor length with overall survival was assessed and compared with other factors detailed in the American Joint Committee on Cancer (AJCC) tumor, node, metastasis (TNM) staging system published in 2009. RESULTS The overall survival (OS) rates at 1, 3, and 5 years were 93.0%, 83.7%, and 69.2%, respectively. The tumor length adversely affected OS, with the 5-year rate being 93.5%, 82.0%, 68.6%, 67.9%, 55.3% and 41.1%, respectively for tumor lengths of less than 10 mm, 10 to 20 mm, 20 to 30 mm, 30 to 40 mm, 40 to 50 mm, and greater than 50 mm (P< 0.001). Multivariate analyses showed that the pathologic T classification and grade of tumor was significantly associated with OS. Tumor length of 30 mm or more remained an independent prognostic factor (P = 0.04), as did the other current TNM factors. CONCLUSION Tumor length appears to affect the OS of patients with early-stage esophageal squamous cell carcinoma. It may provide additional prognostic information for the current TNM staging system.
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Affiliation(s)
- Zhengbo Song
- Department of Chemotherapy, Zhejiang Cancer Hospital, 38 Guangji Road, 310022, Hangzhou, People’s Republic of China
- Key Laboratory Diagnosis and Treatment Technology on Thoracic Oncology, Zhejiang province, Hangzhou, 310022, China
| | - Jiwen Wang
- Key Laboratory Diagnosis and Treatment Technology on Thoracic Oncology, Zhejiang province, Hangzhou, 310022, China
- Department of Thoracic Surgery, Zhejiang Cancer Hospital, Hangzhou, 310022, China
| | - Baochai Lin
- Department of Chemotherapy, Zhejiang Cancer Hospital, 38 Guangji Road, 310022, Hangzhou, People’s Republic of China
- Key Laboratory Diagnosis and Treatment Technology on Thoracic Oncology, Zhejiang province, Hangzhou, 310022, China
| | - Yiping Zhang
- Department of Chemotherapy, Zhejiang Cancer Hospital, 38 Guangji Road, 310022, Hangzhou, People’s Republic of China
- Key Laboratory Diagnosis and Treatment Technology on Thoracic Oncology, Zhejiang province, Hangzhou, 310022, China
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Abstract
The advent of minimally invasive esophagectomy (MIE) attempts to decrease postoperative complications and mortality for this high-risk procedure. This review examines techniques in MIE, associated outcomes, and offers a critical appraisal of the literature surrounding this procedure. A Pubmed search was conducted for "minimally invasive esophagectomy" and associated synonyms. In addition, we analyze the outcomes at our institution through a prospectively maintained database. With varied techniques and utilization of different endpoints it is difficult to draw concrete conclusions from the current literature. Overall, however, there is no strong trend toward deceased mortality or decreased pulmonary complications from MIE, but there is a trend toward decreased intraoperative blood loss and shorter intensive care unit and ward stays. Until future studies are completed, MIE remains a useful tool in the armamentarium of the esophageal surgeon, and should be used not in exclusion of other approaches should patient or tumor factors dictate otherwise.
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Effect of lymph node number on survival of patients with lymph node-negative gastric cancer according to the 7th edition UICC TNM system. PLoS One 2012; 7:e38681. [PMID: 22723875 PMCID: PMC3378541 DOI: 10.1371/journal.pone.0038681] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2011] [Accepted: 05/08/2012] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND For the patients with node-negative gastric cancer, the 7th edition classification does not define the minimum number of lymph nodes necessary. We aimed to explore the prognostic significance of examined lymph nodes and determine how many nodes must be examined. METHODOLOGY/PRINCIPAL FINDINGS 435 patients underwent D2 gastrectomy with node-negative gastric cancer between December 1992 and December 2006 were obtained. Patients were classified into 4 groups by the number of negative LNs examined during surgery (1-6LNs, 7-10 LNs, 11-15 LNs, and > = 16 LNs). Stratified and Cox regression analyses were used to evaluate the association between survival and the number of negative LNs. Survival was significantly better in the > = 16 LNs, compared with the 1-5 LNs, 6-10 LNs and 11-15 LNs group in T2-4 patients; Multivariate analysis demonstrated tumor size, depth of invasion, 7th UICC stage and the number of examined nodes are strongly independent predictors of survival. CONCLUSIONS This study first demonstrates that patients with lymph node-negative gastric cancer underwent D2 dissection should have at least 16 LNs examined, especially in advanced gastric cancer. These results are a reasonable supplement to our previous tumor-ratio-metastasis staging system and a stratification criterion in clinical practice.
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