A More Extensive Lymphadenectomy Enhances Survival After Neoadjuvant Chemoradiotherapy in Locally Advanced Esophageal Adenocarcinoma

医学 危险系数 淋巴结切除术 食管切除术 四分位间距 放化疗 淋巴 置信区间 新辅助治疗 比例危险模型 内科学 肿瘤科 腺癌 淋巴结 食管癌 外科 癌症 病理 乳腺癌
作者
Smita Sihag,Tamar Nobel,Meier Hsu,Kay See Tan,Rebecca Carr,Yelena Y. Janjigian,Laura H. Tang,Abraham J. Wu,Matthew Bott,James M. Isbell,Manjit S. Bains,David R. Jones,Daniela Molena
出处
期刊:Annals of Surgery [Ovid Technologies (Wolters Kluwer)]
卷期号:276 (2): 312-317 被引量:16
标识
DOI:10.1097/sla.0000000000004479
摘要

Objective: We sought to determine the extent of lymphadenectomy that optimizes staging and survival in patients with locally advanced EAC treated with neoadjuvant chemoradiotherapy followed by esophagectomy. Summary of Background Data: Several studies have found that a more extensive lymphadenectomy leads to better disease-specific survival in patients treated with surgery alone. Few studies, however, have investigated whether this association exists for patients treated with neoadjuvant chemoradiotherapy. Methods: We examined our prospective database and identified patients with EAC treated with neoadjuvant chemoradiotherapy followed by esophagectomy between 1995 and 2017. Overall survival (OS) and DFS were estimated using Kaplan-Meier methods, and a multivariable Cox proportional hazards model was used to identify independent predictors of OS and DFS. The relationship between the total number of nodes removed and 5-year OS or DFS was plotted using restricted cubic spline functions. Results: In total, 778 patients met the inclusion criteria. The median number of excised nodes was 21 (interquartile range, 16–27). A lower number of excised lymph nodes was independently associated with worse OS and DFS (OS: hazard ratio, 0.98; confidence interval, 0.97–1.00; P = 0.013; DFS: hazard ratio, 0.99; confidence interval, 0.98–1.00; P = 0.028). Removing 25 to 30 lymph nodes was associated with a 10% risk of missing a positive lymph node. Both OS and DFS improved with up to 20 to 25 lymph nodes removed, regardless of treatment response. Conclusions: The optimal extent of lymphadenectomy to enhance both staging and survival after chemoradiotherapy, regardless of treatment response, is approximately 25 lymph nodes.
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