Schwarz Roderich E, Smith David D
Division of Surgical Oncology, UT Southwestern Cancer Center, Dallas, TX 75390, USA.
J Gastrointest Surg. 2007 Nov;11(11):1384-93; discussion 1393-4. doi: 10.1007/s11605-007-0264-2. Epub 2007 Sep 2.
Esophageal cancer (EC) frequently presents with advanced stages and is associated with high recurrence rates after esophagectomy. The value of an extended lymph node dissection (ELND) remains unclear in this setting. An EC data set was created from the Surveillance, Epidemiology, and End-Results 1973-2003 database. Relationships between the number of lymph nodes (LNs) examined and overall survival (OS) were analyzed. From a cohort of 40,129 EC patients, 5,620 individuals were selected. The median age was 65 (range: 11-102), and 75% were men. The median tumor size was 5.0 cm (0.1-30). On multivariate analysis, total LN count (or negative LN count, respectively) was an independent prognostic variable, aside from age, race, resection status, radiation, T category, N category (all at p < 0.0001), and M category (p = 0.0003). Higher total LN count (>30) and negative LN count (>15) categories were associated with best OS and lowest 90-day mortality (p < 0.0001). The numeric LN effect on OS was independent from nodal status or histology. Greater total and negative LN counts are associated with longer EC survival. Although the mechanism remains uncertain, it does not appear to be limited to stage migration. ELND during potentially curative esophagectomy for EC can be supported by the data.
食管癌（EC）常以晚期表现，且食管切除术后复发率高。在这种情况下，扩大淋巴结清扫术（ELND）的价值仍不明确。利用监测、流行病学和最终结果1973 - 2003数据库创建了一个EC数据集。分析了检查的淋巴结（LN）数量与总生存期（OS）之间的关系。从40129例EC患者队列中，选取了其中5620例个体。中位年龄为65岁（范围：11 - 102岁），75%为男性。中位肿瘤大小为5.0 cm（0.1 - 30 cm）。多因素分析显示，除年龄、种族、切除状态、放疗、T分期、N分期（均p < 0.0001）和M分期（p = 0.0003）外，总LN计数（或阴性LN计数）是一个独立的预后变量。更高的总LN计数（>30）和阴性LN计数（>15）类别与最佳OS和最低的90天死亡率相关（p < 0.0001）。LN数量对OS的影响独立于淋巴结状态或组织学类型。更高的总LN计数和阴性LN计数与EC患者更长的生存期相关。尽管其机制仍不确定，但似乎不限于分期迁移。这些数据可为EC潜在根治性食管切除术中的ELND提供支持。
