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An Evaluation of the Number of Lymph Nodes Examined and Survival for Node-Negative Esophageal Carcinoma: Data from China

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

Abstract

Background

The current American Joint Committee on Cancer (AJCC) staging system for esophageal cancer does not define the minimum number of lymph nodes (LNs) necessary for accurate nodal staging. This study aimed to seek the minimum number of LNs examined for adequate nodal staging of patients with node-negative esophageal cancer.

Methods

We conducted a retrospective review of 592 patients undergoing R0 resection with node-negative esophageal carcinoma between December 1996 and December 2004. The relationship between the total number of examined LNs and death from esophageal cancer was investigated by means of a scatterplot of this variable versus Martingale residuals from a Cox proportional hazard regression model without the variable of interest. A smoothed line fit of the scatterplot was applied to detect the reasonable cutoff point.

Results

The patients were classified into four categories according to the number of examined LNs: ≤5, 6 to 9, 10 to 17, and ≥18. A reduced hazard ratio of death was observed with an increasing number of LNs examined. The 5-year cancer-specific survival rate was 42.8% among patients with ≤5 LNs examined, compared with 52.6, 56.8, and 75% for those with 6–9 LNs, 10–17 LNs, and ≥18 LNs, respectively. Multivariate Cox regression analysis suggested that female sex, lower grade of cell differentiation, lower T category and increasing number of examined LNs were independent factors favoring cancer-specific survival.

Conclusions

At least 18 LNs should be resected for accurate staging of operable esophageal carcinoma. However, a validation from other institute is warranted.

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Acknowledgment

This work was partially supported by grant 5010 from Sun Yat-sen University, which focuses on multidisciplinary therapy on esophageal carcinoma. We thank the members of the Department of Pathology at the Sun Yat-sen University Cancer Center for their cooperation. We also thank Miao-qing Lin for database management and patient follow-up.

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Authors and Affiliations

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

    Hao-Xian Yang MD, PhD, Jian-Hua Fu MD, PhD, Jun-Ye Wang MD, Peng Lin MD, PhD & Tie-Hua Rong MD

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

    Hao-Xian Yang MD, PhD, Jian-Hua Fu MD, PhD, Jun-Ye Wang MD, Peng Lin MD, PhD & Tie-Hua Rong MD

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

    Ying Xu PhD

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  1. Hao-Xian Yang MD, PhD
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Correspondence to Jian-Hua Fu MD, PhD.

Additional information

Hao-Xian Yang and Ying Xu contributed equally to this work.

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Yang, HX., Xu, Y., Fu, JH. et al. An Evaluation of the Number of Lymph Nodes Examined and Survival for Node-Negative Esophageal Carcinoma: Data from China. Ann Surg Oncol 17, 1901–1911 (2010). https://doi.org/10.1245/s10434-010-0948-9

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  • DOI: https://doi.org/10.1245/s10434-010-0948-9

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