Department of Thoracic Surgery, Anhui Provincial Hospital Affiliated with Anhui Medical University, Hefei, 230001, China.
Department of Thoracic Surgery, Anhui Provincial Hospital Affiliated with Anhui Medical University, Hefei, 230001, China.
Int J Surg. 2017 May;41:6-11. doi: 10.1016/j.ijsu.2017.03.028. Epub 2017 Mar 18.
Involvement status of lymph node (LN) is one of the most important prognostic factors for esophagogastric junction (EGJ) adenocarcinoma. However, the prognostic value of the number of examined LNs remains unclear in node-negative (pN0) Siewert type II EGJ adenocarcinoma.
A cohort of 262 patients who underwent curative surgery for pN0 Siewert type II EGJ adenocarcinoma from January 2000 to August 2013 were retrospectively analyzed from high-volume center database. All enrolled patients were categorized into 3 groups according to the number of examined LNs (≤14, 15 to 21, ≥22). Kaplan-Meier curves were used for comparing the differences of cancer-specific survival among groups; Correlation between survival and the number of examined LNs were analyzed by using stratified, uni- and multivariate analyses.
The hazard ratio for cancer-specific mortality decreased sequentially with increasing number of LNs examined. The 5-year cancer-specific survival rates were 45.1%, 58.4% and 65.7% for patients with ≤14 LNs, 15 to 21 and ≥ 22 LNs removed, respectively. The number of removed LNs was significantly correlated with survival in stratified analyses according to T stage. In multivariate model controlling for gender, age, surgical approach, tumor grade, and postoperative chemotherapy, the number of removed LNs and T stage were confirmed to be independent prognostic factors and significantly correlated with disease-specific survival.
The number of examined LNs is an independent prognostic factor of survival for patients with pN0 Siewert type II EGJ adenocarcinoma. Adequate dissection of LNs (more than 15 LNs) is recommended for patients undergoing curative resection.
淋巴结（LN）累及状况是食管胃结合部（EGJ）腺癌最重要的预后因素之一。然而，在无淋巴结转移（pN0）的 Siewert Ⅱ型 EGJ 腺癌中，检查的 LN 数量的预后价值尚不清楚。
回顾性分析了 2000 年 1 月至 2013 年 8 月间在高容量中心数据库中接受根治性手术治疗的 262 例 pN0 Siewert Ⅱ型 EGJ 腺癌患者。所有纳入患者根据检查的 LN 数量（≤14、15~21、≥22）分为 3 组。采用 Kaplan-Meier 曲线比较各组间癌症特异性生存率的差异；采用分层、单因素和多因素分析研究生存与检查的 LN 数量之间的相关性。
癌症特异性死亡率的风险比随着检查的 LN 数量的增加而逐渐降低。接受≤14、15~21 和≥22 枚 LN 清扫的患者 5 年癌症特异性生存率分别为 45.1%、58.4%和 65.7%。根据 T 分期进行分层分析时，切除的 LN 数量与生存显著相关。在多因素模型中，控制性别、年龄、手术方式、肿瘤分级和术后化疗后，切除的 LN 数量和 T 分期被确认为独立的预后因素，并与疾病特异性生存显著相关。
检查的 LN 数量是 pN0 Siewert Ⅱ型 EGJ 腺癌患者生存的独立预后因素。建议对接受根治性切除的患者进行充分的淋巴结清扫（超过 15 枚）。
