Tampere Heart Hospital, Department of Cardiothoracic Surgery, Tampere, Finland.
Faculty of Medicine and Health Technologies, Tampere University, Tampere, Finland.
Eur J Cardiothorac Surg. 2024 Mar 1;65(3). doi: 10.1093/ejcts/ezae090.
The desirable lymph node count was determined to maximize the survival time expectancy according to the lymph node count among patients who have undergone oesophagectomy for oesophageal cancer.
The data of national Finnish population-based cohort including all patients who have undergone oesophagectomy due to oesophageal cancer during 2002-2016 were used. Restricted mean survival time (RMST) estimates were determined by lymph node count, and the desirable count was determined using locally estimated scatterplot smoothing regression.
A total of 883 patients with the median follow-up time of 3.73 (interquartile range 1.43-7.50) years were included. The lymph node count of 27 (95% confidence interval 25-28) was associated with the highest RMST estimates. Sensitivity analyses indicated that in pN0 patients, the highest RMST estimates was observed at 26 (95% confidence interval 24-28) lymph nodes and in pN+ patients, the RMST estimates peaked at 28 (95% confidence interval 25-33) lymph nodes.
According to the findings of this study, at least 24 examined lymph nodes is the recommended target for the lymph node count after oesophagectomy for oesophageal cancer. The beneficial effect of this count on survival may be achieved regardless of nodal metastases.
为了最大化生存时间预期，确定了食管癌患者接受食管癌切除术时的理想淋巴结计数。
使用了包括 2002 年至 2016 年间所有因食管癌接受食管癌切除术的全国芬兰人群队列的数据。通过淋巴结计数确定受限平均生存时间（RMST）估计值，并使用局部估计散点平滑回归确定理想计数。
共纳入 883 例患者，中位随访时间为 3.73 年（四分位距 1.43-7.50）。27 个（95%置信区间 25-28）淋巴结与最高 RMST 估计值相关。敏感性分析表明，在 pN0 患者中，26 个（95%置信区间 24-28）淋巴结观察到最高 RMST 估计值，而在 pN+患者中，RMST 估计值在 28 个（95%置信区间 25-33）淋巴结时达到峰值。
根据这项研究的结果，食管癌切除术至少应检查 24 个淋巴结，这是推荐的淋巴结计数目标。无论淋巴结转移情况如何，该计数对生存的有益影响都可能实现。
