Hanna Jennifer M, Erhunmwunsee Loretta, Berry Mark, D'Amico Thomas, Onaitis Mark
Division of Cardiovascular and Thoracic Surgery, Department of Surgery, Duke University Medical Center, Durham, North Carolina.
Division of Cardiovascular and Thoracic Surgery, Department of Surgery, Duke University Medical Center, Durham, North Carolina.
Ann Thorac Surg. 2015 Jan;99(1):265-9. doi: 10.1016/j.athoracsur.2014.08.073. Epub 2014 Nov 20.
Analyses of adequacy of lymph node dissection during resection of esophageal cancer are based on patients who have not undergone induction chemoradiotherapy. We sought to determine the minimum number of dissected lymph nodes necessary to ensure adequate staging after induction chemoradiotherapy.
A prospectively maintained thoracic surgery database was queried to identify consecutive patients undergoing postinduction esophagectomy from 1996 to 2010. Cox proportional hazard and recursive partitioning survival analyses were performed.
Complete lymph node data were available for 395 patients. Mean age was 59.5 years, and 64 patients (16%) were female. The median number of dissected lymph nodes was 8 (range, 0 to 63). When pathologic (p)T stage, pN stage, and the number of dissected lymph nodes were used as predictors, only pN stage (odds ratio, 1.3; 95% confidence interval, 1.2 to 1.7) and age (odds ratio, 1.03; 95% confidence interval, 1.01 to 1.04) independently predicted survival. Recursive partitioning was performed on 262 pN0 patients using T stage and the number of dissected lymph nodes as predictors. No pN0 patient with 28 lymph nodes dissected died during follow-up. For patients with fewer than 28 lymph nodes dissected, the next prognostic factor was T stage. For pT1-2 N0 patients, the number of lymph nodes dissected did not affect survival. For pT3-4 N0 patients, a significant survival decrement was noted for patients with fewer than 7 lymph nodes dissected compared with those with more than 7 lymph nodes dissected.
T stage determines prognosis in postinduction pN0 patients with fewer than 28 lymph nodes evaluated. Postinduction pT3N0 patients with fewer than 7 lymph nodes evaluated are understaged.
食管癌切除术中淋巴结清扫充分性的分析是基于未接受诱导放化疗的患者。我们试图确定诱导放化疗后确保充分分期所需清扫的最少淋巴结数目。
查询前瞻性维护的胸外科数据库，以识别1996年至2010年间接受诱导后食管切除术的连续患者。进行Cox比例风险和递归划分生存分析。
395例患者有完整的淋巴结数据。平均年龄为59.5岁，64例（16%）为女性。清扫淋巴结的中位数为8个（范围为0至63个）。当将病理（p）T分期、pN分期和清扫淋巴结数目作为预测因素时，只有pN分期（比值比，1.3；95%置信区间，1.2至1.7）和年龄（比值比，1.03；95%置信区间，1.01至1.04）可独立预测生存。对262例pN0患者进行递归划分，将T分期和清扫淋巴结数目作为预测因素。没有清扫28个淋巴结的pN0患者在随访期间死亡。对于清扫淋巴结少于28个的患者，下一个预后因素是T分期。对于pT1-2 N0患者，清扫淋巴结数目不影响生存。对于pT3-4 N0患者，与清扫淋巴结多于7个的患者相比，清扫淋巴结少于7个的患者生存明显下降。
在诱导后评估淋巴结少于28个的pN0患者中，T分期决定预后。诱导后评估淋巴结少于7个的pT3N0患者分期不足。
