Lymph Node Progression and Optimized Node Dissection of Middle Thoracic Esophageal Squamous Cell Carcinoma in the Latest Therapeutic Surgical Strategy

Soeno, Takafumi; Harada, Hiroki; Hosoda, Kei; Mieno, Hiroaki; Ema, Akira; Ushiku, Hideki; Washio, Marie; Kosaka, Yoshimasa; Watanabe, Masahiko; Yamashita, Keishi

doi:10.1245/s10434-019-07190-5

Cited by 8 publications

(10 citation statements)

References 19 publications

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“…Some studies have shown that LNM tended to occur at the supraclavicular area, upper mediastinal area, and upper abdominal area in patients with upper, middle, lower esophageal squamous cell carcinoma, respectively. [ 9 , 12 , 14 , 15 ] In this study, 10 patients had LNM, of which 1 patient had upper mediastinal LNM, and the rest were located in the mediastinal middle and lower group and the upper abdomen group, and had nothing to do with the location of the primary tumor. Previous study reported that the depth of tumor invasion is correlated with LNM in esophageal squamous cell carcinoma.…”

Section: Discussionmentioning

confidence: 83%

Characteristics and prognosis of primary malignant melanoma of the esophagus

Chen

Sun

2020

Medicine

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Primary malignant melanoma of esophagus (PMME) is a rare malignant tumor of esophagus. This study aimed to investigate the clinic pathologic characteristics and analyze the factors that might affect the prognosis of PMME patients. A total of 20 PMME patients who underwent surgical treatment in our hospital from 1975 to 2017 were analyzed. The clinical data, surgical and pathologic features of all patients were collected. For 20 PMME patients, the average age was 57.3 ± 10.7 years, and the male patients account for 75%. Most of the tumors (95%) were located in the middle and lower of the esophagus. There were 7 patients with primary tumor invasion beyond the muscular layer (T3 + T4) and 10 patients with lymph node metastasis (LNM). The median survival time of 20 patients was 12 months, and the 1-year and 5-year survival rates were 50% and 16.9%, respectively. The probability of LNM in tumors confined to submucosa (T1) and myometrium (T2) was lower than that in tumors with deeper invasion (T3, T4) ( P = .035). Multivariate analysis showed that tumor node metastasis (TNM) staging was the independent prognostic factor for survival of PMME patients (hazard ratio [95% confidence interval], 4.15 [1.36–12.67]; P = .012). For PMME patients, tumors with deeper invasion were more likely to have LNM, and TNM staging was an independent predictor of prognosis for survival. Early detection of the disease and radical resection of the tumor are critical for better survival of the PMME patients.

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Section: Discussionmentioning

confidence: 83%

Characteristics and prognosis of primary malignant melanoma of the esophagus

Chen

Sun

2020

Medicine

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“…First proposed by Sasako et al, the therapeutic index has been used in assessing the role of LND in the surgical management of gastric, rectal, esophageal, and lung cancer . In addition, our own group recently examined the therapeutic benefit associated with LND among patients with intrahepatic cholangiocarcinoma and identified particular groups of patients who were most likely to derive a benefit from LND .…”

Section: Discussionmentioning

confidence: 99%

“…The rationale of the therapeutic index is to identify patients who are most likely to have LNM and, therefore, derive a benefit from LND . The therapeutic index concept has been examined and validated for several other cancers including gastric, colorectal, cholangiocarcinoma, and lung . Nevertheless, to date, no study has assessed the therapeutic value of LND among patients with pNETs.…”

Section: Introductionmentioning

confidence: 99%

“…10 The therapeutic index concept has been examined and validated for several other cancers including gastric, colorectal, cholangiocarcinoma, and lung. [10][11][12][13][14] Nevertheless, to date, no study has assessed the therapeutic value of LND among patients with pNETs. As such, the objective of the current study was to define the therapeutic index of LND among patients undergoing resection of pNETs.…”

Section: Introductionmentioning

confidence: 99%

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Therapeutic index of lymphadenectomy among patients with pancreatic neuroendocrine tumors: A multi‐institutional analysis

Sahara

Tsilimigras

et al. 2019

Journal of Surgical Oncology

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Background: The benefit derived from lymph node dissection (LND) in patients with pancreatic neuroendocrine tumors (pNETs) based on clinicopathological characteristics remains unclear.Methods: Patients undergoing surgery for pNET between 1997 and 2016 were identified using a multi-institutional dataset. The therapeutic index of LND relative to patient characteristics was calculated.Results: Among 647 patients, the median number of lymph nodes (LNs) evaluated was 10 (interquartile range: 4-16) and approximately one quarter of patients had lymph node metastasis (LNM) (N = 159, 24.6%). Among patients with LNM, 5-year recurrence-free survival was 56.0%, reflecting a therapeutic index value of 13.8. The therapeutic index was highest among patients with a moderately/poorly-differentiated pNET (21.5), Ki-67 ≥ 3% (20.1), tumor size ≥2.0 cm (20.0), and tumor location at the head of the pancreas (20.0). Patients with ≥8 LNs evaluated had a higher therapeutic index than patients who had 1 to 7 LNs evaluated (≥8: 17.9 vs 1-7: 7.5; difference of index: 11.4).Conclusion: LND was mostly beneficial among patients with pNETs >2 cm, Ki-67 ≥ 3%, and lesions located at the pancreatic head as identification of LNM was most common among individuals with these tumor characteristics. Evaluation of ≥8 LNs was associated with a higher likelihood of identifying LNM as well as a higher therapeutic index, and therefore this number of LNs should be considered the goal. K E Y W O R D S lymphadenectomy, pancreatic neuroendocrine tumor, therapeutic index Lu Wu, Kota Sahara, and Diamantis I. Tsilimigras contributed equally to this work.

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“…In the lymph node maps for esophageal cancer, right recurrent laryngeal nerve nodes (station C201) are located along the right recurrent laryngeal nerve that are superiorly and inferiorly bounded by the cephalic border of the right subclavian artery, and the caudal border of the right recurrent laryngeal nerve curving upward respectively (7), which is equivalent to right upper paratracheal nodes (station 2R) in AJCC/UICC classification (8th). Right upper paratracheal nodes are located between the intersection of the caudal margin of the brachiocephalic artery with the trachea and the apex of the lung (8), station C201 has been documented to be the most frequent site of lymph node metastases of thoracic esophageal squamous cell carcinoma (9)(10)(11). Moreover, recurrent laryngeal nerve injury that is related to station C201 dissection is a common surgical complication that is associated with aspiration pneumonia (12)(13)(14)(15).…”

Section: Introductionmentioning

confidence: 99%

Clinical evaluation of right recurrent laryngeal nerve nodes in thoracic esophageal squamous cell carcinoma

Liu

et al. 2020

J Thorac Dis

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Background: The accuracy of clinical N staging of esophageal squamous cell carcinoma is suboptimal.As an important station of lymph node metastasis, station C201 (right recurrent laryngeal nerve nodes) has rarely been evaluated alone. We aimed to explore an effective way to evaluate the right recurrent laryngeal nerve nodes in thoracic esophageal squamous cell carcinoma.Methods: We retrospectively analyzed 628 thoracic esophageal squamous cell carcinoma patients who underwent radical resection without neoadjuvant therapy from two Chinese cancer centers. The diameter of the short axis of the largest right recurrent laryngeal nerve node (DC201) was measured on contrastenhanced multi-slice computed tomography (MSCT). Right recurrent laryngeal nerve nodes were examined by postoperative pathologic results. The receiver operating characteristic (ROC) curve was generated to assess the diagnostic capabilities of DC201 to determine the right recurrent laryngeal nerve nodes status.Results: ROC curve analysis revealed that the optimal cut-off point of DC201 was 6 mm, with an area under curve (AUC), sensitivity, specificity, and Youden index of 0.896, 71.9%, 88.8%, and 0.607 respectively.When the cut-off point of DC201 was set to 10 mm, sensitivity, specificity and the Youden index were 14.1%, 99.6% and 0.137 respectively. Among 128 patients with right recurrent laryngeal nerve node metastasis, 71 and 108 patients had the largest right recurrent laryngeal nerve node located above the suprasternal notch level and in the tracheoesophageal groove respectively. Conclusions: When DC201 ≥6.0 mm instead of DC201 ≥10 mm was used to dictate the right recurrent laryngeal nerve nodes metastasis, contrast-enhanced MSCT could evaluate the status of right recurrent laryngeal nerve nodes with high sensitivity and specificity. The largest right recurrent laryngeal nerve nodes were mainly located in the tracheoesophageal groove and/or above the suprasternal notch.

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Lymph Node Progression and Optimized Node Dissection of Middle Thoracic Esophageal Squamous Cell Carcinoma in the Latest Therapeutic Surgical Strategy

Cited by 8 publications

References 19 publications

Characteristics and prognosis of primary malignant melanoma of the esophagus

Characteristics and prognosis of primary malignant melanoma of the esophagus

Therapeutic index of lymphadenectomy among patients with pancreatic neuroendocrine tumors: A multi‐institutional analysis

Clinical evaluation of right recurrent laryngeal nerve nodes in thoracic esophageal squamous cell carcinoma

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