Number of negative lymph nodes as a prognostic factor in esophageal squamous cell carcinoma

Ma, Mingquan; Tang, Peng; Jiang, Hongjing; Gong, Lei; Duan, Xiaofeng; Shang, Xianwen; Yu, Zhentao

doi:10.1111/ajco.12567

Cited by 13 publications

(18 citation statements)

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“…However, recent reports have shown that the number of NLN also plays an important role in the prognosis of patients with ESCC that have undergone radical resection of ESCC (18,19). The current study also con rmed that the number of NLN removed in lymphadenectomy was closely associated with the outcome of patients, and further investigation revealed the number of NLN inside the thoracic cavity was an independent predictor for prognosis while the number of NLN outside the thoracic cavity was not an independent prognostic factor.…”

Section: Discussionsupporting

confidence: 74%

The ratio of negative lymph nodes count inside the thoracic cavity to the positive lymph count is a prognostic factor in esophageal squamous cell carcinoma

Zhang

Liu

et al. 2020

Preprint

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BACKROUND: It was reported that the number of positive lymph nodes (PLN) and negative lymph nodes (NLN) resected in lymphadenectomy were both independent prognostic factors in esophageal squamous cell carcinoma (ESCC). However, it is unclear which kind of combination of them would have a stronger impact on the prognosis of the ESCC patients. METHODS: A total of 229 patients with ESCC were retrospectively investigated. The Cox Proportional Hazards Model was used to investigate the relationship between the PLN or NLN and the overall survival of patients. Survival analysis was performed using the Kaplan-Meier method, and the survival difference between sub-groups were explored with log-rank tests. The cut-off number of the ratio of NLN count to PLN count resulted in an improved outcome for patients was investigated by a series of log-rank tests. RESULTSs: The numbers of PLN and NLN were both independent prognostic factors, supported by the results of Cox regression model analysis (hazard ratio [HR], 1.12, P<0.001 and HR, 0.97, P=0.024, respectively).The survival differences among sub-groups from N0 to N3 stage were statistically significant (P<0.001). Analysis using a Cox regression model revealed that the number of NLN inside the thoracic cavity had a stronger impact on the prognosis compared to the number of NLN outside the thoracic cavity (HR,0.959, P=0.042 vs.HR, 0.973, P=0.179). As a combination analysis consisting of the number of PLN and NLN, the log-rank test result demonstrated that patients with the ratio of NLN count inside thoracic cavity to the PLN count less than 8 could achieve a better survival.CONCLUSIONS: The ratio of NLN count inside thoracic cavity to the PLN count was a independent prognostic factor.

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Section: Discussionsupporting

confidence: 74%

The ratio of negative lymph nodes count inside the thoracic cavity to the positive lymph count is a prognostic factor in esophageal squamous cell carcinoma

Zhang

Liu

et al. 2020

Preprint

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“…Baba et al [11] investigated 252 patients with In this retrospective analysis, we evaluated the impact of NLNs number on the survival of a total of 579 thoracic ESCC patients from a single center who all received cura-tive esophagectomy. Ma et al [13] demonstrated that ESCC patients with more than 20 NLNs have better survival rates in contrast to those with less than or equal to 20 NLNs, through retrospective analysis of 381 patients who had underwent surgical resection. Zhang et al [19] retrospectively analyzed 99 patients who were identified with middle thoracic ESCC after esophagectomy and found obvious differences of OS between the following groups: patients with more than and less than 10 NLNs and patients with＞15 and ≤15 NLNs.…”

Section: Discussionmentioning

confidence: 99%

“…In recent years，the number of NLNs has been confirmed to be an important factor related to patient survival in many cancers, proving to be more accurate than the number of positive LNs in predicting patients' prognosis [8][9][10]. Several papers have scrutinized the impact of NLNs on patient survival for EC [11][12][13]. Greenstein et al [12] found that an increasing NLNs count was related to with long-term patient survival in those with lymph node-negative esophageal adenocarcinoma but not in those with the squamous cell subtype.…”

Section: Introductionmentioning

confidence: 99%

“…Greenstein et al [12] found that an increasing NLNs count was related to with long-term patient survival in those with lymph node-negative esophageal adenocarcinoma but not in those with the squamous cell subtype. Another study demonstrated that NLNs count was an advantageous prognostic indicator in lymph node-positive EC patients but not in those who were lymph node-negative [13]. Wu et al [14] draw the conclusion that the number of NLNs was an independent prognostic factor for node-negative EC through a retrospective review of 429 EC patients who underwent modern two-field lymphadenectomy.…”

Section: Introductionmentioning

confidence: 99%

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The number of negative lymph nodes is positively associated with survival in esophageal squamous cell carcinoma patients in China

Zhang

Guan

et al. 2020

Open Medicine

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AbstractBackgroundThere is a controversial relationship between the negative lymph nodes (NLNs) and survival in patients with esophageal squamous cell carcinoma (ESCC). This study investigates the implications of total number of NLNs on thoracic ESCC patient prognosis.Methods579 thoracic ESCC patients were categorized into four groups (0-9, 10-14, 15-19 and ≥20 NLNs). Univariate analysis was done by the log-rank tests while multivariate analysis was undertaken using Cox regression models. Survival analysis was determined employing the Kaplan-Meier method.ResultsWhen the numbers of NLNs were 9 or less, 10 to 14, 15 to 19 and 20 or more, patients of 3-year survival rates were 21.7%, 40.0%, 61.2% and 77.5%, respectively (P<0.001). In the node-negative and node-positive subgroups, 3-year survival rates were 34.9% and 14.3%, 50.9% and 19.3%, 65.6% and 51.8%, 81.4% and 68.9% respectively (P<0.001). Gender, tumor length, tumor differentiation, T and N stage as well as the total NLNs were found to be significantly linked to survival rates. Multivariate analysis showed tumor length, T stage, N stage and total NLNs were independent prognostic factors for ESCC patients.ConclusionNLNs numbers is a significant independent prognostic indicator for thoracic ESCC patients’ survival after curative esophagectomy.

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“…A recent study also showed that the number of negative lymph nodes (NLNs) could impact the OS of patients with ESCC, especially among those with nodal-positive disease and advanced T-stage tumor [ 16 ]. The prognostic value of NLNs was also confirmed in previous studies that revealed that a higher number of NLNs was associated with better OS in EC patients after esophagectomy [ 17 – 18 ].…”

Section: Introductionmentioning

confidence: 99%

Metastatic to negative lymph node ratio demonstrates significant prognostic value in patients with esophageal squamous cell carcinoma after esophagectomy

et al. 2017

Self Cite

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AimsThe prognostic value of metastatic lymph node ratio (LNR) has been reported in some studies; however, there is no report on the prognostic significance of metastatic to negative lymph node ratio (MNLNR) in cancer patients. The aim of this study was to compare the prognostic value of pN, LNR and MNLNR on the survival of patients with esophageal squamous cell carcinoma (ESCC) after esophagectomy.MethodsThe data of 290 patients with ESCC after curative esophagectomy was retrospectively analyzed. The optimal cut-point for LNR and MNLNR were set as 0, 01-0.2, and >0.2. Univariate and multivariate analyses were performed to identify prognostic factors for overall survival (OS).ResultsPatients classified as LNR 0, 0.01-0.20, and 0.21-1.0, the observed 5-year OS rates were 46.6%, 26.0%, and 11.6%, respectively (P = 0.000). Patients classified as MNLNR 0, 0.01-0.20, and >0.2, the observed 5-year OS rates were 46.6%, 31.2%, and 7.4%, respectively, respectively (P = 0.000). The pN stage, LNR or MNLNR category was confirmed as a significant independent prognostic factor, respectively (P = 0.032, P = 0.011 and P = 0.003, respectively); However, only the MNLNR category (P = 0.003) remained as a significant prognostic factor when the pN stage, LNR and MNLNR category simultaneously included in the multivariate analysis models.ConclusionsThe MNLNR was recognized as an independent prognostic factor in ESCC patients after curative esophagectomy. In addition, MNLNR showed better prognostic value than pN stage and LNR category.

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Number of negative lymph nodes as a prognostic factor in esophageal squamous cell carcinoma

Abstract: The number of NLNs, which represents the extent of lymphadenectomy for esophageal squamous cell carcinoma, could impact the overall survival of patients with resected esophageal squamous cell carcinoma, especially among those with nodal-positive disease and advanced T-stage tumor.

Cited by 13 publications

References 18 publications

The ratio of negative lymph nodes count inside the thoracic cavity to the positive lymph count is a prognostic factor in esophageal squamous cell carcinoma

The ratio of negative lymph nodes count inside the thoracic cavity to the positive lymph count is a prognostic factor in esophageal squamous cell carcinoma

The number of negative lymph nodes is positively associated with survival in esophageal squamous cell carcinoma patients in China

Metastatic to negative lymph node ratio demonstrates significant prognostic value in patients with esophageal squamous cell carcinoma after esophagectomy

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