Prognostic impact of examined lymph node count in pT1N0M0 esophageal cancer: A population-based study
Prognostic impact of examined lymph node count in pT1N0M0 esophageal cancer: A population-based study
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DOI：
10.1111/1759-7714.13130
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发表时间：
2019-07-01
期刊：
影响因子：
2.9
通讯作者：
Wang, Hui
中科院分区：
文献类型：
--
作者：
Liu, Ying;Yang, Heli;Wang, Hui
背景：关于淋巴结计数对淋巴结阴性食管癌尤其是pT 1 N 0 M0食管癌的影响研究不足。本研究旨在分析ELN计数对pT 1 N 0 M0 EC预后的影响。方法：从美国监测、流行病学和最终结果（SEER）数据库中提取1988年至2015年切除pT 1 N 0 M0 EC患者的数据。研究ELN计数与总生存期（OS）或食管癌特异性生存期（ECSS）之间的关系。使用Kaplan-Meier方法和考克斯proportional-hazards model.Results确定了可能预测结果的因素：共有906例患者接受切除术，至少有一个淋巴结（LN）检索符合我们的标准。累积5年OS为67.6%，而累积5年ECSS为75.4%。X-Tile分析显示12是ELN计数的最佳截断值，与OS（chi（2）= 28.764，P < 0.0001）和ECSS（chi（2）= 15.668，P = 0.0026）相关。Kaplan-Meier生存分析和对数秩比较显示，ELN > 12与更好的OS（HR，0.532; 95% CI，0.421-0.672; P < 0.001）和ECSS（HR，0.561; 95% CI，0.420-0.749; P < 0.001）率显著相关，而ELN = 12。OS和ECSS的好处，增加ELN计数也反映在多变量分析调整后的年龄，性别，种族，婚姻状况，位置，T分期，肿瘤大小，病理，和differentiation.Conclusions：这些研究结果表明，更多的ELN计数具有预后意义pT 1 N 0 M0 EC。我们建议在pT 1 N 0 M0 EC中应检查12个以上的LN。
Background: Research on the impact of examined lymph node (ELN) count on node-negative esophageal cancer (EC) especially pT1N0M0 EC is inadequate. This study was designed to analyze the prognostic impact of ELN count on pT1N0M0 EC.Methods: Data of resected pT1N0M0 EC patients between 1988 and 2015 were extracted from the United States Surveillance, Epidemiology, and End Results (SEER) database. The association between ELN count and overall survival (OS) or esophageal cancer-specific survival (ECSS) were investigated. Factors that may predict the outcome were identified using the Kaplan-Meier method and the Cox proportional-hazards model.Results: A total of 906 patients who underwent resection with at least one lymph node (LN) retrieved met our criteria. The cumulative 5-year OS was 67.6%, while the cumulative 5-year ECSS was 75.4%. X-Tile analysis showed that 12 was the optimal cutoff value for ELN count in terms of both OS (chi(2) = 28.764, P < 0.0001) and ECSS (chi(2) = 15.668, P = 0.0026). A Kaplan-Meier survival analysis and log-rank comparison revealed that ELN > 12 was significantly associated with better OS (HR, 0.532; 95% CI, 0.421-0.672; P < 0.001) and ECSS (HR, 0.561; 95% CI, 0.420-0.749; P < 0.001) rates than ELN = 12. The OS and ECSS benefit of increasing ELN count were also reflected in the multivariate analysis after adjustment for age, sex, race, marital status, location, T stage, tumor size, pathology, and differentiation.Conclusions: These findings indicated that greater number of ELN count exhibits prognostic significance in pT1N0M0 EC. We recommend more than 12 LNs should be examined in pT1N0M0 EC.