Oesophageal adenocarcinoma has a higher risk of lymph node metastasis than squamous cell carcinoma: a propensity score-matched study

Deng, Han‐Yu; Wang, Zhiqiang; Wang, Yun-Cang; Li, Gang; Luo, Jun; Chen, Long-Qi; Liu, Lunxu; Zhou, Qinghua; Lin, Yi‐Dan

doi:10.1093/ejcts/ezx222

Cited by 17 publications

(14 citation statements)

References 21 publications

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“…We applied multivariate logistic regression analysis to explore potential predictors of LN metastasis (both intrapulmonary/hilar and medisatinal LNs) for these patients, which was based on our discretion by adding all clinically relevant variables. Moreover, we further performed PSM analysis using the PSMATCHING 3.04 and R-2.15.1-win software as previously described 16 to further validate our results based on well-matched cohorts. The following covariates were used for matching: gender, tumor size, histology, tumor differentiation and consistency.…”

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confidence: 93%

Age-different extent of resection for clinical IA non-small cell lung cancer: analysis of nodal metastasis

Deng

Zhou

Wang

et al. 2020

Sci Rep

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Whether age has any impact on the risk of lymph node (LN) metastasis in patients with early-stage non-small cell lung cancer (NSCLC) remains controversial. Therefore, we aimed to objectively compare the risk of LN metastasis between elderly and young patients so as to justify for age-different extent of surgical resection for treating these patients. We retrospectively collected clinical data of patients undergoing lobectomy or segmentectomy with systematic hilar and mediastinal LN dissection for clinical stage IA peripheral NSCLC from January 2015 to December 2018. Both multivariate logistic regression analysis and propensity score-matched (PSM) analysis were applied to compare the risk of LN metastasis between elderly (>65 years old) and young (≤65 years old) patients. We finally included a total of 590 patients for analysis (142 elderly patients and 448 young patients). In the analysis of unmatched cohorts, young patients tended to have higher rates of hilar/intrapulmonary LN (13.4% VS 9.2%) and mediastinal LN metastasis (10.5% VS 6.3%) than elderly patients. In the multivariate analysis, age was found to be an independent predictor of both hilar/intrapulmonary (Odds ratio(OR) = 2.065, 95%confidence interval(CI): 1.049-4.064, P = 0.036) and mediastinal (OR = 2.400, 95%CI: 1.083-5.316, P = 0.031) LN metastasis. Moreover, in the analysis of well-matched cohorts generated by PSM analysis, young patients had significantly higher rates of hilar/intrapulmonary (18.8% VS 9.4%, P = 0.039) and mediastinal LN metastasis (17.1% VS 6.0%, P = 0.008) than elderly patients. Therefore, age remains to be an independent predictor of LN metastasis in early-stage NSCLC and age-different extent of surgical resection may be justified for these patients. Lung cancer has become the leading cause of cancer and cancer-related death worldwide 1 .There are two major types of lung cancer, namely small cell lung cancer(SCLC) and non-small cell lung cancer(NSCLC), of which NSCLC accounted for about 85% 2. With the advancement of computed tomography (CT), more and more early-stage NSCLCs are being found 3,4. For the management of early-stage NSCLC, anatomic lung resection with systematic lymph node (LN) dissection (SLND) or sampling is recommended as the preferred option in the National Comprehensive Cancer Network guideline 5. However, the extent of lung resection and lymphadenectomy for treating early-stage NSCLC depends largely on the characteristics of tumors such as tumor size, status of LN metastasis, histology as well as ground glass consistency 6 and the patient's physiological conditions. It is reported that the age at diagnosis for majority of early-stage NSCLC patients falls into the range from 65 to 79 years old 7 and the number of elderly patients continues to increase with the aging population. Moreover, significant difference of baseline characteristics between elderly and young lung cancer patients was observed 8. However, current guideline still recommends the same surgical strategies for elderly and young patients except fo...

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confidence: 93%

Age-different extent of resection for clinical IA non-small cell lung cancer: analysis of nodal metastasis

Deng

Zhou

Wang

et al. 2020

Sci Rep

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“…[1] In pathology, esophageal cancer mainly consisted of esophageal adenocarcinoma (EA) and esophageal squamous cell carcinoma (SCC). [2] Despite of the advancement of therapeutic strategies, the prognosis of esophageal still remains dismal with a 5-year survival rate of about 15% to 34%. [3] Therefore, investigation on novel potential medications that have anticancer effects for esophageal cancer seems to be greatly important, which might help improve the survival of esophageal cancer patients.…”

Section: Introductionmentioning

confidence: 99%

The association between statin use and survival of esophageal cancer patients

Deng¹,

Lan²,

Zheng³

et al. 2019

Medicine

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Whether statin use has any impact on survival of esophageal cancer patients remains controversial. Therefore, we conducted a meta-analysis focusing on current topic for the first time. We systematically searched the following databases for relevant studies comparing survival between statin users and non-users among esophageal cancer patients up to March 16, 2019: Pubmed, Embase, and Web of Science. We extracted data of hazard ratio (HR) with 95%confidence interval (CI) of all-cause and cancer-specific mortality for analysis. We used the STATA 12.0 software to perform this meta-analysis. We finally included a total of 4 cohort studies involving a total of 20,435 esophageal cancer patients (5319 statin users and 15116 non-users). Our meta-analysis found that statin use after diagnosis of esophageal cancer was significantly correlated to decreased all-cause (random effects: HR = 0.81, 95%CI: 0.75–0.89, P < .001; I 2 = 68.1%) and cancer-specific mortality (fixed effects: HR = 0.84, 95%CI: 0.78–0.89, P < .001; I 2 = 46.6%) in esophageal cancer patients. When stratified by pathological subtypes, the protective effect of statin use after diagnosis of esophageal cancer was observed in both esophageal adenocarcinoma patients and esophageal squamous cell carcinoma patients. Moreover, statin use before diagnosis of esophageal cancer was also confirmed to have favorable survival benefit for esophageal cancer patients. Statin use was significantly correlated to lower mortality risk of esophageal cancer patients regardless of the time when statins were taken and pathological subtypes of esophageal cancer. Statins may serve as promising adjunctive anticancer agents for treating esophageal cancer.

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“…However, some studies reveal significant differences in LNM between esophageal adenocarcinoma and ESCC. According to a propensity matching study by Deng et al , esophageal adenocarcinoma was associated with a higher number of positive lymph nodes and a higher rate of LNM than those of EC ( 15 ). Besides, Rice et al showed that esophageal adenocarcinoma was more prone to LNM than ESCC ( 16 ).…”

Section: Discussionmentioning

confidence: 99%

“…In addition, it is noteworthy that most researchers do not apply different standards of LND scope and number for different tumor types. However, studies have shown that esophageal adenocarcinoma and ESCC possess different characteristics in lymph node metastasis (LNM) ( 15 , 16 ).…”

Section: Introductionmentioning

confidence: 99%

Prognostic significance of the number of lymph nodes dissection in esophageal adenocarcinoma patients

Wang¹,

Yang²,

Shaik³

2020

Transl Cancer Res TCR

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Background Esophagectomy combined with lymphadenectomy has been considered as the preferred treatment option for esophageal cancer (EC). However, for a long time, no consensus is reached on the optimal number and scope of lymph node dissection (LND). In particular, related research on esophageal adenocarcinoma remains lacking at present. To determine the relationship between the number of LND and the prognosis for esophageal adenocarcinoma patients, this study was conducted based on the United States Surveillance, Epidemiology and End Results (SEER) database. Methods Data were extracted from esophageal adenocarcinoma patients undergoing esophagectomy from 2000 to 2016 based on the SEER database. Thereafter, the enrolled patients were divided into five groups according to the number of LND, namely, 0, 1–10, 11–20, 21–30 and >30 LNDs groups. Besides, the Kaplan-Meier product method was applied in estimating the impact of LND number on the overall survival (OS) and disease-specific survival (DSS) of patients. Moreover, the Cox proportional hazard model was employed to analyze the covariates that might affect the results. Results After adjusting for age, gender, race, grade, T stage, tumor location, tumor size and number of positive lymph nodes, differences in OS and DSS were statistically significant among those five groups, and only groups receiving >20 LNDs were related to the improved OS and DSS. Also, it was discovered that, difference in OS was of statistical significance across those five groups in the <50, ≥50 years old, male, Grade I, Grade II, Grade III, T1, T2, T3, and tumor size >4 cm subgroups. Conclusions The number of LND can serve as an independent prognostic factor for OS and DSS among esophageal adenocarcinoma patients. In addition, we recommend that esophageal adenocarcinoma patients should undergo LND to dissect at least 20 lymph nodes.

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Oesophageal adenocarcinoma has a higher risk of lymph node metastasis than squamous cell carcinoma: a propensity score-matched study

Abstract: Cases of oesophageal adenocarcinoma had a higher risk of lymph node metastasis than did those with SCC in this series, which indicates that different therapeutic modalities should be applied for these 2 different malignant entities.

Cited by 17 publications

References 21 publications

Age-different extent of resection for clinical IA non-small cell lung cancer: analysis of nodal metastasis

Age-different extent of resection for clinical IA non-small cell lung cancer: analysis of nodal metastasis

The association between statin use and survival of esophageal cancer patients

Prognostic significance of the number of lymph nodes dissection in esophageal adenocarcinoma patients

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