Department of Thoracic Surgery, First Affiliated Hospital of Zhengzhou University, Zhengzhou.
Department of Thoracic Surgery, Anyang Tumor Hospital, Anyang, Henan Province, China.
Medicine (Baltimore). 2021 Jan 15;100(2):e24100. doi: 10.1097/MD.0000000000024100.
The purpose of this study was to determine whether the number of lymph nodes dissected predicts prognosis in surgically treated elderly patients with pN0 thoracic esophageal cancer. We searched the Surveillance, Epidemiology, and End Results database and identified the records of younger (<75 years) and older (≥75 years) patients with pN0 thoracic esophageal cancer between 1998 and 2015. The patient characteristics, tumor data, and postoperative variables were analyzed in this study. The Kaplan-Meier method and a Cox proportional hazard model were used to compare overall and cause-specific survival. Data from 1,792 esophageal cancer patients (older: n = 295; younger: n = 1497) were included. The survival analysis showed that the overall and cause-specific survival in the patients with ≥15 examined lymph nodes (eLNs) was significantly superior to that in the patients with 1 to 14 eLNs (P < .001); however, the difference disappeared in the older patients. After stratification by the tumor location, histology, pT classification, and differentiation between the younger and older cohorts to analyze the association between eLNs and survival, we found that the differences remained significant in most subgroups in the younger cohort. There were no differences in any subgroups of older patients. This study replicated the previously identified finding that long-term survival in patients with extensive lymphadenectomy was significantly superior to that in patients with less extensive lymphadenectomy. However, less extensive lymphadenectomy may be an acceptable treatment modality for elderly patients with pN0 thoracic esophageal cancer.
本研究旨在确定淋巴结清扫数目是否可预测手术治疗的 pN0 胸段食管鳞癌老年患者的预后。我们检索了 Surveillance, Epidemiology, and End Results（SEER）数据库，并纳入了 1998 年至 2015 年间年龄小于 75 岁（年轻组）和年龄大于等于 75 岁（老年组）的 pN0 胸段食管鳞癌患者的记录。本研究分析了患者特征、肿瘤数据和术后变量。采用 Kaplan-Meier 法和 Cox 比例风险模型比较总生存期和疾病特异性生存期。共纳入 1792 例食管癌患者（老年组：n=295；年轻组：n=1497）。生存分析显示，淋巴结清扫数≥15 枚（eLNs）患者的总生存期和疾病特异性生存期明显优于清扫数 1~14 枚（eLNs）的患者（P<0.001）；然而，这一差异在老年患者中消失。在按肿瘤位置、组织学、pT 分期和年轻与老年队列分层分析 eLNs 与生存的关系后，我们发现 eLNs 与生存的关联在年轻队列的大多数亚组中仍然显著，而在老年患者的任何亚组中均无差异。本研究复制了先前发现的广泛淋巴结清扫术患者的长期生存明显优于较少淋巴结清扫术患者的结果。然而，较少的淋巴结清扫术可能是治疗 pN0 胸段食管鳞癌老年患者的一种可接受的治疗方式。
