<p>The Significance of Negative Lymph Nodes in Esophageal Cancer After Curative Resection: A Retrospective Cohort Study</p>

Abstract

These authors contributed equally to this workObjective: The impact of negative lymph nodes (NLNs) count on prognosis in esophageal cancer (EC) was analyzed using two institutions surgical database. Methods: We conducted a retrospective study of 768 EC patients treated by surgical resection between January 2010 and December 2012. The effects of the NLNs count on prognosis was analyzed. Cox regression model was conducted to determine the significant prognostic elements. Results: The number of NLNs was studied as a categorical variable based on the quartiles (Q1: ≤15, Q2: 16-21, Q3: 22-30, Q4: ≥31). And a better overall survival (OS) was observed with increasing number of NLNs (HR= 0.762; 95% CI, 0.596-0.974 for Q2, HR= 0.666; 95% CI, 0.516-0.860 for Q3 and HR= 0.588; 95% CI, 0.450-0.768 for Q4) (all P<0.05).Multivariate regression analysis revealed that the NLNs count was an independent prognostic factor. Besides, for patients in T2 or T3 stage, a high number of NLNs was found to be significantly associated with a favorable OS (log rank P<0.001). Conclusion: A higher number of NLNs is independently related to the better OS in EC patients after surgical resection.

The Number of Harvested LNs Is an Independent Prognostic Factor in Lymph Node Metastasis-negative Patients Who Received Curative Esophagectomy

“…An important limitation to consider concerning the available data on harvested LNs, including those from the current study, is the lack of a consensus regarding the most appropriate cut-off point for the evaluation of harvested LNs. Mo et al set the cut-off value at 21 in their study of 768 esophageal cancer patients, Greenstein et al set the cut-off value at 18 in their study of 972 esophageal cancer patients, and Xia et al set the cut-off value at 14 and 15 in their study of 7356 esophageal cancer patients (18,20,23). Of course, there are some differences between the present and previous studies that should be mentioned.…”

“…In the present study, the median number of harvested LNs was 31, and the cut-off value of the LNs was 30. In contrast, Mo et al have reported that the mean number of harvested LNs was 23, and the cut-off value of harvested LNs was set at 21 (23). Furthermore, Xia et al have reported that the median number of harvested LNs was 12, and the cut-off value of harvested LNs was set at 14 and 15 (20).…”

Negative lymph node count is an independent prognostic factor for female patients with node positive breast cancer

“…a better overall survival (OS) was observed with increasing number of NLNs and NLN count was an independent prognostic factor(13). Likewise, Hao et al concluded that the high NLN had improved BCSS and OS compared to low NLN and histone modifiers were the most significant…”

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

“…For patients with stage T3 or T4 tumors, which are associated with a much higher chance of lymph node metastasis than other stages, systemic lymphadenectomy should be performed when possible. However, the optimal range of lymph node resection in T1 or T2 ESCC remains controversial, and to our knowledge, no consensus has yet been reached (12,13,(18)(19)(20).…”

“…According to the current clinical guidelines, extensive lymphadenectomy can provide survival benefits and is hence considered the gold standard of treatment ( 11 ). It was suggested that the number of negative lymph nodes (NLNs) was an independent prognostic factor for patients with thoracic esophageal squamous cell carcinoma (ESCC) after radical esophagectomy ( 12 ), wherein a higher ratio of NLNs was independently associated with better OS ( 13 ). Except for the number, resection of certain lymph node stations might also matter in survival outcome based on the analysis of index of estimated benefit from lymph node dissection (IEBLD) ( 14 , 15 ).…”