Bao Tao, Bao Lei, Guo Wei
Department of Thoracic Surgery, Daping Hospital, Army Medical University, Chongqing, China.
Computer Teaching and Research Office, Army Academy of Artillery and Air Defense, Hefei, China.
Front Surg. 2022 Apr 29;9:864593. doi: 10.3389/fsurg.2022.864593. eCollection 2022.
To identify the optimal number of lymph nodes dissected during esophagectomy following neoadjuvant therapy for carcinoma of the esophagus by using the Surveillance, Epidemiology and End Results Registry (SEER) database.
Patients who underwent neoadjuvant Chemoradiotherapy (nCRT) plus esophagectomy with EC from 2001-2016 were analyzed retrospectively in the SEER database. We analyzed the correlation between the lymphadenectomy count and nodal stage migration and overall survival (OS) by using a binary logistic regression model and Cox proportional hazards regression. The curves of the odds ratios (ORs) of nodal stage migration and hazard ratios (HRs) of OS were smoothed using the LOWESS technique, and the cutoff points were determined by the Chow test. The OS curves were calculated with the Kaplan-Meier method.
Among the 4,710 patients analyzed in the SEER database, a median of 12 lymph nodes (IQR, 7-19) were harvested. There was a significantly proportional increase in nodal stage migration (OR, 1.017; 95% CI, 1.011 to 1.023; < 0.001) and serial improvements in OS among node-negative patients (HR, 0.983; 95% CI, 0.977 to 0.988; < 0.001) with an increased ELN count after adjusting for the T stage. The corresponding cutoff point of the 16 ELNs was calculated for the OR of stage migration by the Chow test. For those with node-negative and node-positive diseases, no significant trend of survival benefit that favored a more extensive lymphadenectomy was demonstrated (HR, 1.001; 95% CI, 0.989 to 1.012; = 0.906; and HR, 0.996; 95% CI, 0.985 to 1.006; = 0.405, respectively).
On the basis of these results, we recommend that at least 16 ELNs be removed for accurate nodal staging as well as for obtaining a therapeutic benefit after nCRT for EC. Furthermore, once precise nodal staging has been achieved, patient survival does not improve with additional ELN dissection after nCRT, regardless of pathological nodal staging (negative or positive).
利用监测、流行病学和最终结果登记数据库（SEER）确定食管癌新辅助治疗后食管切除术中清扫淋巴结的最佳数量。
对2001年至2016年在SEER数据库中接受新辅助放化疗（nCRT）加食管癌食管切除术的患者进行回顾性分析。我们使用二元逻辑回归模型和Cox比例风险回归分析淋巴结清扫数量与淋巴结分期转移及总生存期（OS）之间的相关性。使用LOWESS技术对淋巴结分期转移的优势比（OR）曲线和OS的风险比（HR）曲线进行平滑处理，并通过Chow检验确定截断点。采用Kaplan-Meier法计算OS曲线。
在SEER数据库分析的4710例患者中，中位清扫淋巴结数为12个（四分位间距，7 - 19个）。在调整T分期后，随着清扫淋巴结数（ELN）增加，淋巴结分期转移呈显著比例增加（OR，1.017；95%置信区间，1.011至1.023；<0.001），淋巴结阴性患者的OS持续改善（HR，0.983；95%置信区间，0.977至0.988；<0.001）。通过Chow检验计算出16个ELN时的分期转移OR的相应截断点。对于淋巴结阴性和阳性疾病患者，未显示出更广泛的淋巴结清扫有利于生存获益的显著趋势（HR分别为1.001；95%置信区间，0.989至1.012；P = 0.906；以及HR为0.996；95%置信区间，0.985至1.006；P = 0.405）。
基于这些结果，我们建议至少清扫16个ELN以进行准确的淋巴结分期，并在食管癌新辅助放化疗后获得治疗益处。此外，一旦实现精确的淋巴结分期，新辅助放化疗后额外清扫ELN并不能改善患者生存，无论病理淋巴结分期为阴性或阳性。
