Risk Factors and Prognostic Impact of Mediastinal Lymph Node Metastases in Patients with Esophagogastric Junction Cancer

Shiraishi, Osamu; Yasuda, Takushi; Katô, Hiroaki; Iwama, Mitsuru; Hirabayashi, Yoko; Yasuda, Atsushi; Shinkai, Masayuki; Kimura, Yutaka; Imano, Motohiro

doi:10.1245/s10434-020-08579-3

Cited by 21 publications

(20 citation statements)

References 26 publications

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“…16a2/b1 nodes as well as the middle and upper mediastinal nodes, needed not be routinely resected because of less metastasis and marginal benefits. Considering the benefit-risk balance, an optional station for en block dissection depended on the predominant location (epicenter location) and tumor extension (Borrmann type III and IV) (19,33,36,38,39,(44)(45)(46). The lower perigastric nodes should be resected in the stomach-predominant tumor with gastric involvement exceeding 5.0 cm, whereas the middle and upper mediastinal nodes should be resected in the esophagus-predominant tumor with esophageal involvement exceeding 3.0 cm, splenic hilar nodes in the Grecurvature-predominant tumor, and the paraaortic nodes in those with nodal involvement at the left pericardia or left gastric artery.…”

Section: Discussionmentioning

confidence: 99%

Mapping of lymph node dissection determined by the epicenter location and tumor extension for esophagogastric junction carcinoma

Liang

Bi²,

Fan³

et al. 2022

Front. Oncol.

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BackgroundsPrevious studies identified the extent of lymph node dissection for esophagogastric junction (EGJ) carcinoma based on the metastatic incidence. The study aimed to determine the optimal extent and priority of lymphadenectomy based on the therapeutic efficacy from each station.MethodsThe studies on the lymph node metastasis (LNM) and therapeutic efficacy index (EI) for EGJ carcinomas were identified until April 2022. The obligatory stations with the LNM rates over 5% and therapeutic EI exceeding 2% should be routinely resected for D2 dissection, whereas the optional stations with EI between 0.5% and 2% should be resected for D3 dissection in selective cases.ResultsThe survey yielded 16 eligible articles including 6,350 patients with EGJ carcinoma. The metastatic rates exceeded 5% at no. 1, 2, 3, 7, 9, 11p, and 110 stations and were less than 5% in abdominal no. 4sa~6, 8a, 10, 11d, 12a, and 16a2/b1 and mediastinal no. 105~112 stations. Consequently, obligatory stations with EI over 2% were largely determined by the epicenter location and located at the upper perigastric, lower mediastinal, and suprapancreatic zones, corresponding to those with rates of LNM over 5%. Consistent with the LNM rates less than 5%, the optional stations with EI between 0.5% and 2% were largely dependent on the degree of tumor extension toward the lower perigastric, splenic hilar (grecurvature), para-aortic (less curvature of the cardia), and middle or upper mediastinal zones.ConclusionsThe obligatory stations can be resected as an “envelope-like” wrap by transhiatal proximal gastrectomy with lower esophagectomy, whereas the optional stations for dissection are indicated by the tumor extension. The extended gastrectomy is required for the lower perigastric in the stomach-predominant tumor with gastric involvement exceeding 5.0 cm, para-aortic dissection in the less curvature-predominant tumor and splenic hilar dissection in the grecurvature-predominant tumor whereas transthoracic subtotal esophagectomy is required for complete mediastinal dissection and adequate negative margin in the esophagus-predominant tumor with esophageal invasion exceeding 3.0 cm.

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Section: Discussionmentioning

confidence: 99%

Mapping of lymph node dissection determined by the epicenter location and tumor extension for esophagogastric junction carcinoma

Liang

Bi²,

Fan³

et al. 2022

Front. Oncol.

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“…Esophagogastric junction (EGJ) cancer has been increasing not only in the United States and Western countries but also in Japan[ 1 - 5 ]. However, the optimal surgical approach for EGJ cancer remains controversial[ 6 ]. Despite improvements in surgical procedures and peri-operative patients management, the complications after surgery for EGJ cancer remain high because of technical aspects[ 7 ].…”

Section: Introductionmentioning

confidence: 99%

Association of anastomotic leakage with long-term oncologic outcomes of patients with esophagogastric junction cancer

Takeuchi¹,

Kawakubo²,

Matsuda³

et al. 2022

WJGS

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BACKGROUND Despite improvements in surgical procedures and peri-operative patients management, the postoperative complications in esophagogastric junction (EGJ) cancer remain high because of technical aspects. Several studies have indicated the negative influence of postoperative infectious complications on long-term survival after gastrointestinal surgery. However, no study has shown the association between postoperative complications and long-term survival of patients with EGJ cancer. AIM To elucidate influence of postoperative complications on the long-term outcomes of patients with EGJ cancer. METHODS A total of 122 patients who underwent surgery for EGJ cancer at the Keio University were included in this study. We examined the association between complications and long-term oncologic outcomes. RESULTS In all patients, the 3-year overall survival (OS) rate was 71.9%, and the recurrence-free survival (RFS) rate was 67.5%. Compared with patients without anastomotic leakage, those with anastomotic leakage had poor median OS (8 mo vs not reached, P = 0.028) and median RFS (5 mo vs not reached, P = 0.055). Among patients with cervical anastomosis, there were not significant differences between patients with and without anastomotic leakage. However, among patients who underwent intrathoracic anastomosis, patients with anastomotic leakage had significantly worse OS ( P = 0.002) and RFS ( P = 0.005). CONCLUSION Anastomotic leakage was significantly associated with long-term oncologic outcomes of patients with EGJ cancer, especially those who underwent intrathoracic anastomosis. Cervical anastomosis with subtotal esophagectomy may be an option for the patients who are at high risk for anastomotic leakage.

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“…Lymph node metastasis is a well-known prognostic factor for HPSCC. Most recent studies on the parameters include the total number of harvested lymph nodes (HLNs) and the number of positive lymph nodes (PLNs) (3,4). Low values of the parameters, which are affected by the cervical lymphatic dissection technique, may result in misdiagnosis and eventually lead to an inaccurate treatment.…”

Section: Introductionmentioning

confidence: 99%

Comparison of three lymph node staging methods for predicting outcome in patients with stage Ⅲ-Ⅳ hypopharyngeal squamous cell carcinoma

Wang

Zhang²,

HSUEH

et al. 2022

Preprint

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Background: Lymph node ratio (LNR), log odds of positive lymph nodes (LODDS), and the number of postoperative lymph node staging (pN) are prognostic indicators of various cancers. However, comparison of the prognostic values of these indicators remains unclear in hypopharyngeal squamous cell carcinoma (HPSCC). This study aims to compare the prognostic values of LNR, LODDS and pN in stage Ⅲ-Ⅳ HPSCC. Methods: We conducted a retrospective study on 166 patients with stage Ⅲ-Ⅳ HPSCC. LNR and LODDS were divided into two groups using X-tile version 3.6.1. Univariate and multivariate analyses of the risk of overall survival (OS) and disease-free survival (DFS) were performed using the log-rank (Mantel-Cox) test and the Cox proportional hazards model, respectively. We compared the prognostic value of LNR with that of LODDS and pN using receiver operating characteristic (ROC) curves. Results: According to the X-tile, the cut-off values are 0.11 for LNR and -0.91 for LODDS. LNR, LODDS, and pN were significantly correlated with DFS by univariate analysis (P < 0.05). Multivariate analysis demonstrated that LNR was an independent prognostic factor for DFS (P < 0.01). Multivariate analysis also revealed that postoperative tumour staging (pT) classification, LNR, and surgical margins were independent prognostic factors for OS. Compared with pN and LODDS, LNR showed a stronger predictive power for DFS. Conclusion: LNR may be a better predictor for DFS than pN and LODDS in stage Ⅲ-Ⅳ HPSCC patients. LNR in the highest tertile (≥ 0.11) may cause poor OS and DFS. LODDS in the highest tertile (≥-0.91) may cause poor DFS.

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Risk Factors and Prognostic Impact of Mediastinal Lymph Node Metastases in Patients with Esophagogastric Junction Cancer

Cited by 21 publications

References 26 publications

Mapping of lymph node dissection determined by the epicenter location and tumor extension for esophagogastric junction carcinoma

Mapping of lymph node dissection determined by the epicenter location and tumor extension for esophagogastric junction carcinoma

Association of anastomotic leakage with long-term oncologic outcomes of patients with esophagogastric junction cancer

Comparison of three lymph node staging methods for predicting outcome in patients with stage Ⅲ-Ⅳ hypopharyngeal squamous cell carcinoma

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