Department of Medical Imaging, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, 250021, People's Republic of China.
Department of Thoracic Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, 250021, People's Republic of China.
BMC Cancer. 2021 Apr 14;21(1):403. doi: 10.1186/s12885-021-08080-4.
Clinically, there are no clear guidelines on the extent of lymphadenectomy in patients with T1 esophageal cancer. Studying the minimum number of lymph nodes for resection may increase cancer-specific survival.
Patients who underwent esophagectomy and lymphadenectomy at T1 stage were selected from the Surveillance, Epidemiology and End Results Program (United States, 1998-2014). Maximally selected rank and Cox proportional hazard models were used to examine three variables: the number of lymph nodes examined, the number of negative lymph nodes and the lymph node ratio.
Approximately 18% had lymph node metastases, where the median values were 10, 10 and 0 for the number of lymph nodes examined, the number of negative lymph nodes and the lymph node ratio, respectively. All three examined variables were statistically associated with cancer-specific survival probability. Dividing patients into two groups shows a clear difference in cancer-specific survival compared to four or five groups for all three variables: there was a 29% decrease in the risk of death with the number of lymph nodes examined ≥14 vs < 14 (hazard ratio 0.71, 95% confidence interval: 0.57-0.89), a 35% decrease in the risk of death with the number of negative lymph nodes ≥13 vs < 13 (hazard ratio 0.65, 95% confidence interval: 0.52-0.81), and an increase of 1.21 times in the risk of death (hazard ratio 2.21, 95% confidence interval: 1.76-2.77) for the lymph node ratio > 0.05 vs ≤ 0.05.
The extent of lymph node dissection is associated with cancer-specific survival, and the minimum number of lymph nodes that need to be removed is 14. The number of negative lymph nodes and the lymph node ratio also have prognostic value after lymphadenectomy among T1 stage patients.
临床上，对于 T1 期食管癌患者的淋巴结清扫范围尚无明确指南。研究淋巴结切除的最小数量可能会提高癌症特异性生存率。
从美国监测、流行病学和最终结果计划（1998-2014 年）中选择 T1 期行食管切除术和淋巴结清扫术的患者。采用最大选择秩和 Cox 比例风险模型检查三个变量：检查的淋巴结数量、阴性淋巴结数量和淋巴结比率。
约 18%的患者发生淋巴结转移，检查的淋巴结数量、阴性淋巴结数量和淋巴结比率的中位数分别为 10、10 和 0。所有三个检查的变量均与癌症特异性生存概率具有统计学关联。将患者分为两组，与所有三个变量的四组或五组相比，癌症特异性生存有明显差异：检查的淋巴结数量≥14 与<14 的死亡风险降低 29%（风险比 0.71，95%置信区间：0.57-0.89），阴性淋巴结数量≥13 与<13 的死亡风险降低 35%（风险比 0.65，95%置信区间：0.52-0.81），淋巴结比率>0.05 与≤0.05 的死亡风险增加 1.21 倍（风险比 2.21，95%置信区间：1.76-2.77）。
淋巴结清扫的范围与癌症特异性生存率相关，需要切除的最小淋巴结数量为 14 个。在 T1 期患者中，淋巴结清扫后阴性淋巴结数量和淋巴结比率也具有预后价值。
