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Prognostic value of the extent of lymphadenectomy for esophageal cancer-specific survival among T1 patients
Department of Medical Imaging, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China.
Department of Thoracic Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China.
Department of Respiratory and Critical care, Shandong Public Health Clinical Center, Jinan, China.
Umeå University, Faculty of Arts, Várdduo – Centre for Sámi Research.
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2021 (English)In: BMC Cancer, ISSN 1471-2407, E-ISSN 1471-2407, Vol. 21, no 1, article id 403Article in journal (Refereed) Published
Abstract [en]

Background: 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.

Methods: 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.

Results: 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.

Conclusions: 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.

Place, publisher, year, edition, pages
2021. Vol. 21, no 1, article id 403
Keywords [en]
Cancer-specific survival, Cutoff value, Esophageal cancer, Extent of lymphadenectomy, Prognosis, T1
National Category
Cancer and Oncology
Identifiers
URN: urn:nbn:se:umu:diva-182757DOI: 10.1186/s12885-021-08080-4ISI: 000640498200002PubMedID: 33853577Scopus ID: 2-s2.0-85104388002OAI: oai:DiVA.org:umu-182757DiVA, id: diva2:1556654
Available from: 2021-05-24 Created: 2021-05-24 Last updated: 2023-09-05Bibliographically approved

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Liu-Helmersson, Jing

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