Lu Yifei, Ye Minhua, Ma Dehua, Chen Yu
Department of Cardiology, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Linhai, People's Republic of China.
Department of Thoracic Surgery, Taizhou Hospital of Zhejiang Province affiliated to Wenzhou Medical University, Linhai, People's Republic of China.
Int J Gen Med. 2024 Oct 14;17:4633-4643. doi: 10.2147/IJGM.S480893. eCollection 2024.
To explore the association between survival status and the number of resected lymph nodes in node-negative esophageal squamous cell carcinoma(ESCC) after surgical treatment.
This was a retrospective observational cohort study and data were obtained from the Surveillance, Epidemiology, and End Results program (SEER) and TaiZhou hospital in China. The data for subjects with negative lymph nodes and no distant metastasis (pN0M0) after post-operative pathology were screened. The nonlinear relationship between resected lymph node number and survival status in node-negative ESCC was conducted using restricted cubic spline regression analysis. The association between the number of resected lymph nodes and survival status in node-negative ESCC was evaluated by Cox proportional hazards regression models. Subgroup analysis based on different subgroups was also performed.
A total of 999 subjects were included in the study. Restricted cubic spline regression was used to show a U shaped association between the number of resected lymph nodes and survival status in node-negative ESCC, with low count associated with a decreased survival. To elucidate the association, we adjusted for age, sex, race, T stage, TNM (tumor node metastasis classification), location, grade, chemotherapy, and radiotherapy. As the resected lymph node number increased by one node, the survival status was improved by 2% (Hazard ratio(HR) = 0.98, 95% confidence interval (CI) 0.98-0.99). Sensitivity analysis indicate that the effect size and direction in different subgroups are consistent, the results is stability in SEER.
A low count of resected lymph nodes correlated with reduced survival in patients with ESCC, where resecting 25 to 28 or more nodes is considered optimal. Larger prospective studies are warranted to confirm these findings.
探讨手术治疗后淋巴结阴性的食管鳞状细胞癌（ESCC）患者的生存状况与切除淋巴结数量之间的关联。
这是一项回顾性观察队列研究，数据来自美国监测、流行病学和最终结果计划（SEER）以及中国台州医院。筛选术后病理显示淋巴结阴性且无远处转移（pN0M0）患者的数据。采用受限立方样条回归分析淋巴结阴性ESCC患者切除淋巴结数量与生存状况之间的非线性关系。通过Cox比例风险回归模型评估淋巴结阴性ESCC患者切除淋巴结数量与生存状况之间的关联。还进行了基于不同亚组的亚组分析。
本研究共纳入999名受试者。采用受限立方样条回归分析显示，淋巴结阴性ESCC患者切除淋巴结数量与生存状况呈U形关联，切除淋巴结数量少与生存率降低相关。为阐明这种关联，我们对年龄、性别、种族、T分期、TNM（肿瘤淋巴结转移分类）、位置、分级、化疗和放疗进行了校正。随着切除淋巴结数量增加1个，生存状况改善2%（风险比（HR）=0.98，95%置信区间（CI）0.98 - 0.99）。敏感性分析表明，不同亚组的效应大小和方向一致，SEER中的结果具有稳定性。
ESCC患者切除淋巴结数量少与生存率降低相关，切除25至28个或更多淋巴结被认为是最佳的。需要更大规模的前瞻性研究来证实这些发现。
