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Impact of Examined Lymph Node Count for Esophageal Squamous Cell Carcinoma in Patients who Underwent Right Transthoracic Esophagectomy

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

Abstract

Background

The impact of the number of examined lymph nodes (ELNs) on stage correction and prognostication in patients with esophageal squamous cell carcinoma (ESCC) who underwent right transthoracic esophagectomy is still unclear.

Methods

Patients with ESCC who underwent right transthoracic esophagectomy at Sun Yat-sen University Cancer Center between January 1997 and December 2013 were retrospectively enrolled. The Cox proportional hazards regression model was used to determine the effect of ELN count on overall survival. The impact of ELN count on stage correction was evaluated using the hypergeometric distribution and Bayes theorem and β-binomial distribution estimation, respectively. The threshold of ELNs was determined using the LOWESS smoother and piecewise linear regression.

Results

Among the 875 included patients, greater ELNs were associated with a higher rate of nodal metastasis. Significant association between staging bias and the number of ELNs is only observed through the Bayes method. The ELN count did not impact 90-day mortality but significantly impacted long-term survival (adjusted hazard ratio [aHR] 0.986), especially in those patients with node-negative disease (aHR 0.972). In patients with node-negative disease, cut-point analysis showed a threshold ELN count of 21.

Conclusions

A greater number of ELNs is associated with more accurate node staging and better long-term survival in resected ESCC patients. We recommended harvesting at least 21 LNs to acquire accurate staging and long-term survival information for patients with declared node-negative disease using the right thoracic approach.

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Acknowledgments

This study was supported by the Medical Scientific Research Foundation of Guangdong Province of China (Grant No. A2020150), Natural Science Foundation of Guangdong Province of China (Grant Nos. 2017A030310641, 2018A030313762), and Medical Scientific Research Foundation of Guangdong Province of China (Grant No. A2018301).

Funding

The funding source had no role in the design of this study and did not have any role during its execution, analyses, interpretation of the data, or decision to submit the results.

Author information

Author notes

  1. Yu-Zhen Zheng and Xiao-Qiang Li have contributed equally to this work.

Authors and Affiliations

  1. Department of Thoracic Oncology, State Key Laboratory of Oncology in South China, Collaborative Innovation, Sun Yat-sen University Cancer Center, No.651, Dongfeng Road East, Guangzhou, 510060, Guangdong, China

    Yu-Zhen Zheng MD, Jun-Ye Wang MD, Hong Yang MD, Jing Wen MD, Wen-Yu Zhai MD & Jian-Hua Fu MD

  2. Department of Thoracic Surgery, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China

    Yu-Zhen Zheng MD & Hong-Ying Liao MD

  3. Department of Thoracic Surgery, Peking University Shenzhen Hospital, Shenzhen, China

    Xiao-Qiang Li MD

  4. Office of Research Service, Third Affiliation Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China

    Lian-Xiong Yuan MD

  5. Department of Ultrasonography, Guangzhou First People’s Hospital, Guangzhou Medical University, Guangzhou, China

    Shen-Shen Fu MD

Authors
  1. Yu-Zhen Zheng MD
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  2. Xiao-Qiang Li MD
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  3. Jun-Ye Wang MD
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  4. Hong Yang MD
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  5. Jing Wen MD
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  8. Shen-Shen Fu MD
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  9. Hong-Ying Liao MD
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  10. Jian-Hua Fu MD
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Corresponding authors

Correspondence to Hong-Ying Liao MD or Jian-Hua Fu MD.

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Supplementary Fig. S1

Distribution of the number of harvested lymph nodes (TIFF 92 kb)

Supplementary Fig. S2

Probability of false stage and confidence of accurate nodal stage when a different number of LNs is examined in patients with N0, N1, and N2 status (TIFF 1507 kb)

Supplementary Fig. S3

Overall survival stratified by examined lymph node (ELN) count of 21 for the entire, N−, and N+ cohorts (TIFF 885 kb)

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Zheng, YZ., Li, XQ., Wang, JY. et al. Impact of Examined Lymph Node Count for Esophageal Squamous Cell Carcinoma in Patients who Underwent Right Transthoracic Esophagectomy. Ann Surg Oncol 28, 3025–3033 (2021). https://doi.org/10.1245/s10434-020-09217-8

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  • DOI: https://doi.org/10.1245/s10434-020-09217-8

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