为实现 T1-2 期食管鳞癌准确的淋巴结分期和最佳生存，所需检查的最少淋巴结数目：一项回顾性多中心队列研究及 SEER 数据库验证。
The minimum number of examined lymph nodes for accurate nodal staging and optimal survival of stage T1-2 esophageal squamous cell carcinoma: A retrospective multicenter cohort with SEER database validation.
机构信息
Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, 610041, China; Department of Cardiothoracic Intensive Care Unit, Affiliated Hospital of North Sichuan Medical College, Nanchong, 637000, China; Academician (Expert) Workstation, Affiliated Hospital of North Sichuan Medical College, Nanchong 637000, China.
College of Stomatology, North Sichuan Medical College, Nanchong, China.
出版信息
Int J Surg. 2022 Aug;104:106764. doi: 10.1016/j.ijsu.2022.106764. Epub 2022 Jul 6.
BACKGROUND
The extent of lymphadenectomy during esophagectomy remains controversial for patients with T1-2 ESCC. The aim of this study was to identify the minimum number of examined lymph node (ELN) for accurate nodal staging and overall survival (OS) of patients with T1-2 esophageal squamous cell carcinoma (ESCC).
MATERIALS AND METHODS
Patients with T1-2 ESCC from three institutes between January 2011 and December 2020 were retrospectively reviewed. The associations of ELN count with nodal migration and OS were evaluated using multivariable models, and visualized by using locally weighted scatterplot smoothing (LOWESS). Chow test was used to determine the structural breakpoints of ELN count. External validation in the SEER database was performed.
RESULTS
In total, 1537 patients were included. Increased ELNs was associated with an increased likelihood of having positive nodal disease and incremental OS. The minimum numbers of ELNs for accurate nodal staging and optimal survival were 14 and 18 with validation in the SEER database (n = 519), respectively. The prognostic prediction ability of N stage was improved in the group with ≥14 ELNs compared with those with fewer ELNs (iAUC, 0.70 (95%CI 0.66-0.74) versus 0.61(95%CI 0.57-0.65)). The higher prognostic value was found for patients with ≥18 ELNs than those with <18 ELNs (iAUC, 0.78 (95%CI 0.74-0.82) versus 0.73 (95%CI 0.7-0.77)).
CONCLUSION
The minimum numbers of ELNs for accurate nodal staging and optimal survival of stage T1-2 ESCC patients were 14 and 18, respectively.
背景
在 T1-2 期食管鳞癌（ESCC）患者中，淋巴结清扫的范围仍存在争议。本研究旨在确定 T1-2 期食管鳞状细胞癌患者准确淋巴结分期和总生存（OS）所需的最小检查淋巴结（ELN）数量。
材料和方法
回顾性分析了 2011 年 1 月至 2020 年 12 月三所医院的 T1-2 期 ESCC 患者。使用多变量模型评估 ELN 计数与淋巴结转移和 OS 的关系，并通过局部加权散点平滑（LOWESS）进行可视化。Chow 检验用于确定 ELN 计数的结构断点。在 SEER 数据库中进行外部验证。
结果
共纳入 1537 例患者。增加 ELN 与阳性淋巴结疾病的发生几率和增量 OS 相关。在 SEER 数据库（n=519）中进行验证，准确淋巴结分期和最佳生存的最小 ELN 数量分别为 14 和 18。与 ELN 较少的患者相比，ELN 计数≥14 的患者的 N 分期预后预测能力得到改善（iAUC，0.70（95%CI 0.66-0.74）vs. 0.61（95%CI 0.57-0.65））。与 ELN<18 的患者相比，ELN 计数≥18 的患者具有更高的预后价值（iAUC，0.78（95%CI 0.74-0.82）vs. 0.73（95%CI 0.7-0.77））。
结论
准确淋巴结分期和 T1-2 期 ESCC 患者最佳生存的最小 ELN 数量分别为 14 和 18。
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