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The Positive Lymph Node Ratio Predicts Long-Term Survival in Patients with Operable Thoracic Esophageal Squamous Cell Carcinoma in China

  • Thoracic Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Controversy exists concerning the optimal cutoff points for the positive lymph node ratio (PLNR) to predict overall survival. We aim to propose reasonable PLNR categories for the discrimination of the survival difference between groups.

Methods

We used data from two centers to establish a training (n = 1006) and a validation (n = 783) cohort. All of the patients underwent curative surgical treatment. Martingale residuals from a Cox proportional hazards regression model were used to determine the optimal cutoff points for PLNR to predict overall survival. The survival rate was calculated using the Kaplan–Meier method, and a log-rank test was used to assess the survival differences between groups. The results obtained from the training cohort were tested with the validation cohort at each step.

Results

We classified the patients into four revised nodal categories: R-pN0 (PLNR = 0), R-pN1 (0< PLNR ≤0.1), R-pN2 (0.1< PLNR ≤0.3), and R-pN3 (PLNR >0.3). Subgroup analysis for the pT2 and pT3 cases showed that the survival differences could be well discriminated between groups based on PLNR in both the training cohort and validation cohort. When we modified the current staging system using revised nodal categories (based on PLNR) instead of the AJCC nodal categories, the survival rate could also be easily distinguished between patients in different stages in both cohorts of patients.

Conclusions

The survival rate of ESCC can be discriminated between four groups: PLNR = 0, 0< PLNR ≤0.1, 0.1< PLNR ≤0.3, and PLNR >0.3. Further studies are required to confirm these results.

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References

  1. Bogoevski D, Onken F, Koenig A, Kaifi JT, Schurr P, Sauter G, et al. Is it time for a new TNM classification in esophageal carcinoma? Ann Surg. 2008;247:633–41.

    Article  PubMed  Google Scholar 

  2. Dhar DK, Hattori S, Tonomoto Y, Shimoda T, Kato H, Tachibana M, et al. Appraisal of a revised lymph node classification system for esophageal squamous cell cancer. Ann Thorac Surg. 2007;83:1265–72.

    Article  PubMed  Google Scholar 

  3. Eloubeidi MA, Desmond R, Arguedas MR, Reed CE, Wilcox CM. Prognostic factors for the survival of patients with esophageal carcinoma in the U.S.: the importance of tumor length and lymph node status. Cancer. 2002;95:1434–43.

    Article  PubMed  Google Scholar 

  4. Greenstein AJ, Litle VR, Swanson SJ, Divino CM, Packer S, Wisnivesky JP. Prognostic significance of the number of lymph node metastases in esophageal cancer. J Am Coll Surg. 2008;206:239–46.

    Article  PubMed  Google Scholar 

  5. Hagen JA, DeMeester SR, Peters JH, Chandrasoma P, DeMeester TR. Curative resection for esophageal adenocarcinoma: analysis of 100 en bloc esophagectomies. Ann Surg. 2001;234:520–30.

    Article  PubMed  CAS  Google Scholar 

  6. Kunisaki C, Akiyama H, Nomura M, Matsuda G, Otsuka Y, Ono HA, et al. Developing an appropriate staging system for esophageal carcinoma. J Am Coll Surg. 2005;201:884–90.

    Article  PubMed  Google Scholar 

  7. Mariette C, Piessen G, Briez N, Triboulet JP. The number of metastatic lymph nodes and the ratio between metastatic and examined lymph nodes are independent prognostic factors in esophageal cancer regardless of neoadjuvant chemoradiation or lymphadenectomy extent. Ann Surg. 2008;247:365–71.

    Article  PubMed  Google Scholar 

  8. Van Sandick JW, van Lanschot JJ, ten Kate FJ, Tijssen JG, Obertop H. Indicators of prognosis after transhiatal esophageal resection without thoracotomy for cancer. J Am Coll Surg. 2002;194:28–36.

    Article  PubMed  Google Scholar 

  9. Wijnhoven BP, Tran KT, Esterman A, Watson DI, Tilanus HW. An evaluation of prognostic factors and tumor staging of resected carcinoma of the esophagus. Ann Surg. 2007;245:717–25.

    Article  PubMed  Google Scholar 

  10. Hsu WH, Hsu PK, Hsieh CC, Huang CS, Wu YC. The metastatic lymph node number and ratio are independent prognostic factors in esophageal cancer. J Gastrointest Surg. 2009;13:1913–20.

    Article  PubMed  Google Scholar 

  11. Liu YP, Ma L, Wang SJ, Chen YN, Wu GX, Han M, et al. Prognostic value of lymph node metastases and lymph node ratio in esophageal squamous cell carcinoma. Eur J Surg Oncol. 2010;36:155–9.

    Article  PubMed  CAS  Google Scholar 

  12. Wilson M, Rosato EL, Chojnacki KA, Chervoneva I, Kairys JC, Cohn HE, et al. Prognostic significance of lymph node metastases and ratio in esophageal cancer. J Surg Res. 2008;146:11–5.

    Article  PubMed  Google Scholar 

  13. Kelty CJ, Kennedy CW, Falk GL. Ratio of metastatic lymph nodes to total number of nodes resected is prognostic for survival in esophageal carcinoma. J Thorac Oncol. 2010;5:1467–71.

    Article  PubMed  Google Scholar 

  14. Fox M, Farmer R, Scoggins CR, McMasters KM, Martin RC 2nd. Lymph node ratio is a significant predictor of disease-specific mortality in patients undergoing esophagectomy for cancer. Am Surg. 2012;78:528–34.

    PubMed  Google Scholar 

  15. Corley DA, Buffler PA. Oesophageal and gastric cardia adenocarcinomas: analysis of regional variation using the Cancer Incidence in Five Continents database. Int J Epidemiol. 2001;30:1415–25.

    Article  PubMed  CAS  Google Scholar 

  16. Hongo M, Nagasaki Y, Shoji T. Epidemiology of esophageal cancer: Orient to Occident. Effects of chronology, geography and ethnicity. J Gastroenterol Hepatol. 2009;24:729–35.

    Article  PubMed  Google Scholar 

  17. Veeramachaneni NK, Zoole JB, Decker PA, Putnam JB, Jr., Meyers BF. Lymph node analysis in esophageal resection: American College of Surgeons Oncology Group Z0060 trial. Ann Thorac Surg. 2008;86:418–21.

    Article  PubMed  Google Scholar 

  18. Law S, Wong J. Changing disease burden and management issues for esophageal cancer in the Asia-Pacific region. J Gastroenterol Hepatol. 2002;17:374–81.

    Article  PubMed  Google Scholar 

  19. Rice TW, Blackstone EH, Rusch VW. Esophagus and esophagastric junction. In: Edge SB, Byrd DR, Compton CC, Fritz AG, Greene FL, Trotti A III, eds. AJCC Cancer Staging Manual. 7th ed. New York: Springer; 2009:103–15.

    Google Scholar 

  20. Yang HX, Xu Y, Fu JH, Wang JY, Lin P, Rong TH. An evaluation of the number of lymph nodes examined and survival for node-negative esophageal carcinoma: data from China. Ann Surg Oncol. 2010;17:1901–11.

    Article  PubMed  Google Scholar 

  21. Yang HX, Hou X, Liu QW, Zhang LJ, Liu JG, Lin P, et al. Tumor location does not impact long-term survival in patients with operable thoracic esophageal squamous cell carcinoma in China. Ann Thorac Surg. 2012;93:1861–6.

    Article  PubMed  Google Scholar 

  22. Grambsch PM, Therneau TM, Fleming TR. Diagnostic plots to reveal functional form for covariates in multiplicative intensity models. Biometrics. 1995;51:1469–82.

    Article  PubMed  CAS  Google Scholar 

  23. Yang HX, Wei JC, Xu Y, Liu JG, Lin P, Rong TH, Fu JH. Modification of nodal categories in the seventh american joint committee on cancer staging system for esophageal squamous cell carcinoma in Chinese patients. Ann Thorac Surg. 2011;92:216–24.

    Article  PubMed  Google Scholar 

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Acknowledgment

This work was supported by the Young Scientists Fund of the National Natural Science Foundation of China (81000935), the Young Teachers’ Training Program of Sun Yat-sen University (11ykpy59), and the Guangdong Provincial Science and Technology Planning Foundation (2011B031800179).

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Authors and Affiliations

  1. Department of Medical Oncology, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, People’s Republic of China

    Xue Hou MD

  2. State Key Laboratory of Oncology in South China, Guangzhou, Guangdong, People’s Republic of China

    Xue Hou MD, Rong-Zhen Luo PhD, Jian-Hua Fu MD, Lan-Jun Zhang MD, Peng Lin MD & Hao-Xian Yang MD

  3. Department of Thoracic Surgery, Linzhou Esophageal Cancer Hospital, Yaocun, Linzhou, Henan, People’s Republic of China

    Jin-Chang Wei MD

  4. Institute of Medical Statistics and Epidemiology, Guangdong Pharmaceutical University, Guangzhou, Guangdong, People’s Republic of China

    Ying Xu PhD

  5. Department of Pathology, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, People’s Republic of China

    Rong-Zhen Luo PhD

  6. Department of Thoracic Surgery, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, People’s Republic of China

    Jian-Hua Fu MD, Lan-Jun Zhang MD, Peng Lin MD & Hao-Xian Yang MD

Authors
  1. Xue Hou MD
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  2. Jin-Chang Wei MD
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  3. Ying Xu PhD
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  4. Rong-Zhen Luo PhD
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  5. Jian-Hua Fu MD
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  6. Lan-Jun Zhang MD
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  7. Peng Lin MD
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  8. Hao-Xian Yang MD
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Corresponding author

Correspondence to Hao-Xian Yang MD.

Additional information

Xue Hou and Jin-Chang Wei contributed equally to this study and share the first authorship.

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Hou, X., Wei, JC., Xu, Y. et al. The Positive Lymph Node Ratio Predicts Long-Term Survival in Patients with Operable Thoracic Esophageal Squamous Cell Carcinoma in China. Ann Surg Oncol 20, 1653–1659 (2013). https://doi.org/10.1245/s10434-012-2794-4

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  • DOI: https://doi.org/10.1245/s10434-012-2794-4

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