Retrospective Cohort Study
Copyright ©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. Jun 27, 2024; 16(6): 1537-1547
Published online Jun 27, 2024. doi: 10.4240/wjgs.v16.i6.1537
Optimal extent of lymphadenectomy improves prognosis and guides adjuvant chemotherapy in esophageal cancer: A propensity score-matched analysis
Ji-Ming Tang, Shu-Jie Huang, Qi-Bin Chen, Han-Sheng Wu, Gui-Bin Qiao
Ji-Ming Tang, Shu-Jie Huang, Qi-Bin Chen, Gui-Bin Qiao, Department of Thoracic Surgery, Guangdong Provincial People’s Hospital, Guangzhou 510080, Guangdong Province, China
Han-Sheng Wu, Department of Thoracic Surgery, The First Affiliated Hospital of Shantou University Medical College, Shantou 515041, Guangdong Province, China
Author contributions: Tang JM, Huang SJ, and Chen QB contributed to the conceptualization, data curation, and formal analysis of this study; Tang JM, Huang SJ, Chen QB, and Wu HS were involved in the investigation, methodology of this manuscript; Wu HS contributed to the software, validation, and visualization of this study; Tang JM, Huang SJ, Chen QB, Wu HS, and Qiao GB participated in the writing - original draft, review and editing; Qiao GB contributed to the project administration, resources, and supervision of this study.
Institutional review board statement: The ethics committee of the two hospitals approved our work (No. GDREC2019687H).
Informed consent statement: Written consent was waived due to the retrospective nature of this study.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: The dataset is available from the corresponding author upon reasonable request.
STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Gui-Bin Qiao, MD, PhD, Chief Physician, Department of Thoracic Surgery, Guangdong Provincial People’s Hospital, No. 106 Zhongshan Er Road, Yuexiu District, Guangzhou 510080, Guangdong Province, China. guibinqiao@126.com
Received: December 27, 2023
Revised: April 29, 2024
Accepted: May 16, 2024
Published online: June 27, 2024
Processing time: 185 Days and 16.7 Hours
Abstract
BACKGROUND

The optimal extent of lymphadenectomy in esophageal squamous cell carcinoma (ESCC) patients remained debatable.

AIM

To explore the ideal number of cleared lymph nodes in ESCC patients undergoing upfront surgery.

METHODS

In this retrospective, propensity score-matched study, we included 1042 ESCC patients who underwent esophagectomy from November 2008 and October 2019. Patients who underwent neoadjuvant therapy were excluded. We collected patients’ clinicopathological features and information regarding lymph nodes, including the total number of resected lymph nodes (NRLN), and pathologically diagnosed positive lymph nodes (RPLN). SPSS and R software were used for statistical analysis.

RESULTS

Among the included 1042 patients, two cohorts: ≤ 21 (n = 664) and > 21 NRLN (n = 378) were identified. The final prognostic model included four variables: T stage, N, venous thrombus, and the number of removed lymph nodes. Among them, NRLN > 21 was determined as an independent prognosticator after surgery for esophageal cancer (hazards regression = 0.66, 95% confidence interval: 0.50-0.87, P = 0.004). A nomogram was created based on the regression coefficients of the variables in the final model. In the training cohort, the predictive model displayed an uncorrected five-year overall survival C-index of 0.659, with a bootstrap-corrected C-index of 0.654. In the subgroup analysis, adjuvant chemotherapy was beneficial in the subgroup with NRLN > 21 and RPLN ≤ 0.16 and NRLN ≤ 21 and RPLN > 0.16.

CONCLUSION

NRLN > 21 was an independent prognostic factor after ESCC surgery. The combination of NRLN and RPLN may provide a reference for adjuvant chemotherapy use in potential beneficiaries.

Keywords: Esophageal squamous cell carcinoma; Lymphadenectomy; Adjuvant chemotherapy; Prognosis; Nomogram

Core Tip: This study delineates the prognostic value of the number of lymph nodes removed during esophagectomy in esophageal squamous cell carcinoma (ESCC) patients, highlighting that a count greater than 21 significantly improves survival outcomes. It introduces a novel prognostic model, incorporating lymph node count with clinical variables, and proposes a nuanced approach to post-operative adjuvant chemotherapy based on lymph node ratio. These insights affirm the importance of extensive lymphadenectomy in ESCC and offer a refined strategy for tailoring adjuvant treatment, thereby enhancing personalized patient care.