Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai, China.
Dis Esophagus. 2020 Jan 16;33(1). doi: 10.1093/dote/doz009.
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.
在接受或不接受新辅助治疗的食管癌切除术时，解剖足够数量的淋巴结（LNs）对于确保分期准确性至关重要。我们开发了一个统计模型，根据先前的研究来量化基于精确淋巴结分期的概率。我们回顾性地分析了 Surveillance, Epidemiology, and End Results 数据库中接受食管癌切除术的患者。采用β二项式分布来根据阳性和检查的 LNs 数量来估计欠分期患者的数量。使用 6252 名患者，我们估计在不接受新辅助治疗的情况下，检查 17 个 LNs 可以获得 90%的准确 N0 分期的置信度。为了在 N1 和 N2 中获得类似的准确性，应该检查 20 和 25 个 LNs。对于接受新辅助治疗的患者，检查 18、19 和 28 个 LNs 可以达到相同的准确性。分期准确性是一个重要的预后因素。我们发现，当达到 90%的置信度时，随着检查的 LNs 数量增加，患者的生存并没有改善，阳性 LNs 的比例和对数优势也没有显著的预后价值。我们为不同 N 分期患者开发的用于精确分期的统计模型在指导淋巴结切除术方面具有重要价值。它为低估的淋巴结转移提供了风险评估，并指导了随后的辅助治疗。
