Impact of the number of resected lymph nodes on survival after preoperative radiotherapy for esophageal cancer

Abstract

To assess the impact of the number of resected lymph nodes (RLNs) for survival in esophageal cancer (EC) patients treated with preoperative radiotherapy and cancer-directed surgery. The Surveillance Epidemiology and End Results (SEER) database was queried to identify EC patients treated from 1988 to 2012 who had complete data on the number of positive lymph nodes and number of RLNs. Kaplan–Meier survival analysis and Cox regression proportional hazard methods were used to determine factors that significantly impact cause-specific survival (CSS) and overall survival (OS). There were a total of 3,159 patients who received preoperative radiotherapy and cancer-directed surgery. The median number of RLNs was 10 in both patients who received and did not receive preoperative radiotherapy (P = 0.332). Cox regression univariate and multivariate analysis showed that RLN count was a significant prognostic factor for CSS and OS. Patients with 11–71 RLNs had better CSS (hazard ratio [HR] = 0.694, 95% confidence interval [CI]: 0.603–0.799, P < 0.001) and OS (HR = 0.724, 95% CI: 0.636–0.824, P < 0.001) than patients with 1–10 RLNs. The 5-year CSS rates were 39.1% and 44.8% in patients with 1–10 RLNs and 11–71 RLNs, respectively (P < 0.001). The 5-year OS rates were 33.7% and 39.9% in patients with 1–10 RLNs and 11–71 RLNs, respectively (P < 0.001). A higher number of RLNs was associated with better survival by tumor stage and nodal stage (all P < 0.05). RLN count is an independent prognostic factor in EC patients who undergo preoperative radiotherapy and cancer-directed surgery.

Neoadjuvant therapy in relation to lymphadenectomy and resection margins during surgery for oesophageal cancer

“…A register-based study from the United States on patients undergoing oesophagectomy for gastroesophageal cancers (n = 18,777) suggested that neoadjuvant therapy was associated with a decreased likelihood of obtaining 15 or more nodes, but did not assess specific numbers of nodes 37 . Another register-based study from the United States (n = 5,805), a Taiwanese register-based study (n = 2,151), and a hospital-based study (n = 111) from the United States found no association between neoadjuvant therapy and lymph node yield in oesophageal cancer 14 , 15 , 38 , but none of these studies adjusted the results for surgeon volume, or other potential confounders.…”

Robot-Assisted Hybrid Esophagectomy Is Associated with a Shorter Length of Stay Compared to Conventional Transthoracic Esophagectomy: A Retrospective Study

“…The impact of the extent of lymph node resection on long-term survival is much debated. Some papers advocate that the number of removed lymph nodes is an independent prognostic marker [ 19 ]. Other reports state that increasing the number of harvested lymph nodes does not per se offer any improvement in the survival [ 20 ].…”

The Effect of Lymph Nodes’ Histologic Response on Survival Outcomes in Moroccan Patients with Rectal Cancer

“…Neoadjuvant treatment based on exclusive radiotherapy or chemoradiotherapy followed by surgical resection is the current practice in locally advanced rectal cancer (T3 or T4 tumors, with or without lymph nodes metastasis) [15]. Lymph node status is recently the powerful indicator factor for prognosis in posttherapeutic rectal cancer [8,16]. General guidelines recommend the evaluation of a number of 12 regional LNs to validate an accurate ypN0 status [4,14,15].…”

“…Lymph node (LN) status appears to occupy a more critical role in therapeutic strategy decisions after surgical procedure [7]. erefore, the presence of positive lymph nodes is considered to be a poor prognosis value of metastasis and recurrence [8]. Semiquantitative evaluation of primary tumor regression on surgical specimens, after neoadjuvant treatment, was assessed by different systems [9].…”