Optimal Range of Lymphadenectomy in Pathological Stage T1 and T2 Esophageal Squamous Cell Carcinoma

Overview

Journal Front Oncol

Specialty Oncology

Date 2021 Jun 11

PMID 34113556

Authors

Hansheng Wu

Weitao Zhuang

Shujie Huang

Xueting Guan

Yuju Zheng

Zefeng Xie

Gang Chen

Jiming Tang

Haiyu Zhou

Liang Xie

Xiaosong Ben

Zihao Zhou

Zijun Li

Rixin Chen

Guibin Qiao

Affiliations

Soon will be listed here.

Abstract

Background: Lymph node metastasis is a primary contributor to tumor progression in esophageal squamous cell carcinoma (ESCC), and the optimal extent of lymphadenectomy during esophagectomy remains controversial. This study aimed to investigate the appropriate number of lymph nodes to be dissected in pT1-2Nany stage ESCC to achieve the best prognosis and avoid missing positive lymph nodes (PLNs).

Methods: A total of 497 patients with pT1 to pT2 esophageal cancer from two institutions were retrospectively analyzed and their surgical and pathological records were critically reviewed. Stepwise analyses were conducted by calculating a serial of hazard ratios and odd ratios to determine the optimal range of lymphadenectomy for overall survival (OS).

Results: The best survival outcome can be obtained when the number of lymph node examined (NLNE) is 10-18 in pT1N0 ESCC, while the NLNE should exceed 24 in pT2N0 diseases. In patients with pT1-2Nany and pT2Nany ESCC, resection of 15-25 and 24-37 lymph nodes, respectively, could provide significant added value for identifying positive nodal metastasis. When the NLNE exceeds this appropriate range, resection of extra lymph node is not helpful to improve the probability of finding PLNs.

Conclusions: For ESCC patients undergoing radical esophagectomy, the optimal extent of lymphadenectomy is 15-25 for pT1Nany disease and 24-37 for pT2Nany disease.

References

Xu G, Jin M, Shao Y, Chen Y, Ning Z . Prognostic value of the number of lymph nodes resected in patients with lymph-node-negative esophageal squamous cell carcinoma. Int J Clin Exp Pathol. 2020; 13(3):597-606. PMC: 7137011. View

Rizk N, Ishwaran H, Rice T, Chen L, Schipper P, Kesler K . Optimum lymphadenectomy for esophageal cancer. Ann Surg. 2009; 251(1):46-50. DOI: 10.1097/SLA.0b013e3181b2f6ee. View

Mo J, Chen D, Li C, Chen M . The Significance of Negative Lymph Nodes in Esophageal Cancer After Curative Resection: A Retrospective Cohort Study. Cancer Manag Res. 2020; 12:1269-1279. PMC: 7039082. DOI: 10.2147/CMAR.S232856. View

Domper Arnal M, Ferrandez Arenas A, Lanas Arbeloa A . Esophageal cancer: Risk factors, screening and endoscopic treatment in Western and Eastern countries. World J Gastroenterol. 2015; 21(26):7933-43. PMC: 4499337. DOI: 10.3748/wjg.v21.i26.7933. View

Zhu Z, Chen H, Yu W, Fu X, Xiang J, Li H . Number of negative lymph nodes is associated with survival in thoracic esophageal squamous cell carcinoma patients undergoing three-field lymphadenectomy. Ann Surg Oncol. 2014; 21(9):2857-63. DOI: 10.1245/s10434-014-3665-y. View

van der Schaaf M, Johar A, Wijnhoven B, Lagergren P, Lagergren J . Extent of lymph node removal during esophageal cancer surgery and survival. J Natl Cancer Inst. 2015; 107(5). DOI: 10.1093/jnci/djv043. View

Doescher J, Veit J, Hoffmann T . [The 8th edition of the AJCC Cancer Staging Manual : Updates in otorhinolaryngology, head and neck surgery]. HNO. 2017; 65(12):956-961. DOI: 10.1007/s00106-017-0391-3. View

Groth S, Virnig B, Whitson B, DeFor T, Li Z, Tuttle T . Determination of the minimum number of lymph nodes to examine to maximize survival in patients with esophageal carcinoma: data from the Surveillance Epidemiology and End Results database. J Thorac Cardiovasc Surg. 2009; 139(3):612-20. DOI: 10.1016/j.jtcvs.2009.07.017. View

Zhou L, Zhao Y, Zheng Y, Wang M, Tian T, Lin S . The Prognostic Value of the Number of Negative Lymph Nodes Combined with Positive Lymph Nodes in Esophageal Cancer Patients: A Propensity-Matched Analysis. Ann Surg Oncol. 2020; 27(6):2042-2050. DOI: 10.1245/s10434-019-08083-3. View

10.

Peyre C, Hagen J, DeMeester S, Altorki N, Ancona E, Griffin S . The number of lymph nodes removed predicts survival in esophageal cancer: an international study on the impact of extent of surgical resection. Ann Surg. 2008; 248(4):549-56. DOI: 10.1097/SLA.0b013e318188c474. View

11.

Rice T, Ishwaran H, Hofstetter W, Kelsen D, Apperson-Hansen C, Blackstone E . Recommendations for pathologic staging (pTNM) of cancer of the esophagus and esophagogastric junction for the 8th edition AJCC/UICC staging manuals. Dis Esophagus. 2016; 29(8):897-905. PMC: 5591444. DOI: 10.1111/dote.12533. View

12.

Schlick C, Khorfan R, Odell D, Merkow R, Bentrem D . Adequate Lymphadenectomy as a Quality Measure in Esophageal Cancer: Is there an Association with Treatment Approach?. Ann Surg Oncol. 2020; 27(11):4443-4456. PMC: 7282211. DOI: 10.1245/s10434-020-08578-4. View

13.

Cormier J, Askew R, Mungovan K, Xing Y, Ross M, Armer J . Lymphedema beyond breast cancer: a systematic review and meta-analysis of cancer-related secondary lymphedema. Cancer. 2010; 116(22):5138-49. DOI: 10.1002/cncr.25458. View

14.

Schaapveld M, de Vries E, van der Graaf W, Otter R, De Vries J, Willemse P . The prognostic effect of the number of histologically examined axillary lymph nodes in breast cancer: stage migration or age association?. Ann Surg Oncol. 2006; 13(4):465-74. DOI: 10.1245/ASO.2006.02.020. View

15.

Altorki N, Zhou X, Stiles B, Port J, Paul S, Lee P . Total number of resected lymph nodes predicts survival in esophageal cancer. Ann Surg. 2008; 248(2):221-6. DOI: 10.1097/SLA.0b013e31817bbe59. View

16.

Siegel R, Miller K, Jemal A . Cancer statistics, 2019. CA Cancer J Clin. 2019; 69(1):7-34. DOI: 10.3322/caac.21551. View

17.

Ye T, Sun Y, Zhang Y, Zhang Y, Chen H . Three-field or two-field resection for thoracic esophageal cancer: a meta-analysis. Ann Thorac Surg. 2013; 96(6):1933-41. DOI: 10.1016/j.athoracsur.2013.06.050. View

18.

Fox M, Farmer R, Scoggins C, McMasters K, Martin 2nd R . Lymph node ratio is a significant predictor of disease-specific mortality in patients undergoing esophagectomy for cancer. Am Surg. 2012; 78(5):528-34. View

19.

Yu L, Zhang X, Guan S, Cheng Y, Li L . The Number of Negative Lymph Nodes is Positively Associated with Survival in Esophageal Squamous Cell Carcinoma Patients in China. Open Med (Wars). 2020; 15:152-159. PMC: 7065439. DOI: 10.1515/med-2020-0023. View

20.

Johnson P, Porter G, Ricciardi R, Baxter N . Increasing negative lymph node count is independently associated with improved long-term survival in stage IIIB and IIIC colon cancer. J Clin Oncol. 2006; 24(22):3570-5. DOI: 10.1200/JCO.2006.06.8866. View