Department of Thoracic Surgery, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Guangdong Esophageal Cancer Institute, Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong, China; Department of Thoracic Surgery, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.
Department of Thoracic Surgery, Peking University Shenzhen Hospital, Shenzhen, China.
Eur J Surg Oncol. 2020 Oct;46(10 Pt A):1956-1962. doi: 10.1016/j.ejso.2020.04.047. Epub 2020 May 4.
The impact of the number of examined lymph nodes (ELNs) on stage correction and prognostication in patients with oesophageal squamous cell carcinoma (ESCC) who underwent left transthoracic oesophagectomy is still unclear.
Patients with ESCC who underwent left transthoracic oesophagectomy at Sun Yat-sen University Cancer Center between January 1997 and December 2013 were retrospectively enrolled. The Cox proportional hazards regression model was used to determine the effect of ELN count on overall survival (OS). The association between ELN count and nodal status was investigated through scatter plot and binary logistic regression analyses. The impact of ELN count on stage correction was evaluated using the hypergeometric distribution and Bayes theorem. The threshold of ELNs was determined using the LOWESS smoother and piecewise linear regression.
Among the 1826 included patients, greater ELNs were associated with a higher rate of nodal metastasis (adjusted OR = 1.018). When the ELN count increased, the omission rate of positive lymph nodes (LNs) decreased. The ELN count did not impact 90-day mortality but significantly impacted long-term survival (adjusted HR = 0.983), especially in those with node-negative disease (adjust HR = 0.972). In patients with node-negative disease, cut point analysis showed a threshold ELN count of 18.
A greater number of ELNs is associated with more accurate node staging and better long-term survival in resected ESCC patients. We recommended harvesting at least 18 LNs to acquire accurate staging and long-term survival information for patients with declared node-negative disease in the left thoracic approach.
在接受左开胸食管癌切除术的食管鳞状细胞癌（ESCC）患者中，检查的淋巴结数量（ELN）对分期校正和预后的影响尚不清楚。
回顾性纳入中山大学肿瘤防治中心 1997 年 1 月至 2013 年 12 月期间接受左开胸食管癌切除术的 ESCC 患者。使用 Cox 比例风险回归模型确定 ELN 计数对总生存（OS）的影响。通过散点图和二项逻辑回归分析研究 ELN 计数与淋巴结状态的关系。使用超几何分布和贝叶斯定理评估 ELN 计数对分期校正的影响。使用 LOWESS 平滑和分段线性回归确定 ELN 的阈值。
在 1826 名纳入的患者中，ELN 数量越大，淋巴结转移率越高（调整后的 OR=1.018）。随着 ELN 计数的增加，阳性淋巴结（LNs）的遗漏率降低。ELN 计数不影响 90 天死亡率，但显著影响长期生存（调整后的 HR=0.983），尤其是在淋巴结阴性疾病患者中（调整后的 HR=0.972）。在淋巴结阴性疾病患者中，切点分析显示 ELN 计数的截断值为 18。
更多的 ELN 与接受切除术的 ESCC 患者更准确的淋巴结分期和更好的长期生存相关。我们建议在左胸入路中，为宣布淋巴结阴性的患者采集至少 18 个淋巴结，以获取准确的分期和长期生存信息。
