Memorial Sloan-Kettering Cancer Center, New York, NY, USA.
Ann Surg. 2010 Jan;251(1):46-50. doi: 10.1097/SLA.0b013e3181b2f6ee.
Using Worldwide Esophageal Cancer Collaboration data, we sought to (1) characterize the relationship between survival and extent of lymphadenectomy, and (2) from this, define optimum lymphadenectomy.
What constitutes optimum lymphadenectomy to maximize survival is controversial because of variable goals, analytic methodology, and generalizability of the underpinning data.
A total of 4627 patients who had esophagectomy alone for esophageal cancer were identified from the Worldwide Esophageal Cancer Collaboration database. Patient-specific risk-adjusted survival was estimated using random survival forests. Risk-adjusted 5-year survival was averaged for each number of lymph nodes resected and its relation to cancer characteristics explored. Optimum number of nodes that should be resected to maximize 5-year survival was determined by random forest multivariable regression.
For pN0M0 moderately and poorly differentiated cancers, and all node-positive (pN+) cancers, 5-year survival improved with increasing extent of lymphadenectomy. In pN0M0 cancers, no optimum lymphadenectomy was defined for pTis; optimum lymphadenectomy was 10 to 12 nodes for pT1, 15 to 22 for pT2, and 31 to 42 for pT3/T4, depending on histopathologic cell type. In pN+M0 cancers and 1 to 6 nodes positive, optimum lymphadenectomy was 10 for pT1, 15 for pT2, and 29 to 50 for pT3/T4.
Greater extent of lymphadenectomy was associated with increased survival for all patients with esophageal cancer except at the extremes (TisN0M0 and >or=7 regional lymph nodes positive for cancer) and well-differentiated pN0M0 cancer. Maximum 5-year survival is modulated by T classification: resecting 10 nodes for pT1, 20 for pT2, and >or=30 for pT3/T4 is recommended.
利用全球食管癌协作组的数据，我们旨在（1）描述生存与淋巴结清扫范围之间的关系，以及（2）由此确定最佳淋巴结清扫范围。
由于目标、分析方法以及基础数据的通用性存在差异，因此，何种淋巴结清扫范围能够实现最佳生存尚存争议。
我们从全球食管癌协作组数据库中确定了 4627 例单独接受食管癌切除术的患者。使用随机生存森林法估计患者特异性风险调整生存情况。对每个切除淋巴结数的风险调整 5 年生存率进行平均计算，并对其与癌症特征的关系进行了研究。通过随机森林多变量回归确定了为最大化 5 年生存率应切除的最佳淋巴结数量。
对于 pN0M0 中低分化癌和所有淋巴结阳性（pN+）癌，随着淋巴结清扫范围的扩大，5 年生存率得到提高。在 pN0M0 癌症中，pTis 无最佳淋巴结清扫范围；pT1 最佳淋巴结清扫范围为 10 至 12 个，pT2 为 15 至 22 个，pT3/T4 为 31 至 42 个，具体取决于组织病理学细胞类型。在 pN+M0 癌症和 1 至 6 个淋巴结阳性的情况下，pT1 的最佳淋巴结清扫范围为 10 个，pT2 为 15 个，pT3/T4 为 29 至 50 个。
除了两端（TisN0M0 和> 7 个区域淋巴结有癌症转移）和高分化 pN0M0 癌症外，对所有食管癌患者进行更大范围的淋巴结清扫与生存获益相关。最大 5 年生存率受 T 分类的调节：推荐对 pT1 切除 10 个淋巴结，对 pT2 切除 20 个淋巴结，对 pT3/T4 切除> 或=30 个淋巴结。
