Optimum Lymphadenectomy for Esophageal Cancer
| Autor: | Thomas W. Rice, Wayne L. Hofstetter, Carolyn E. Reed, Hemant Ishwaran, Kenneth A. Kesler, Eugene H. Blackstone, Walter J. Scott, Chen Lq, Thomas J. Watson, Paul H. Schipper, Nabil P. Rizk, Toni Lerut, Jarmo A. Salo, Simon Law, Valerie W. Rusch, Mark S. Allen |
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| Rok vydání: | 2010 |
| Předmět: |
Male
Oncology medicine.medical_specialty Lymphatic metastasis Esophageal Neoplasms medicine.medical_treatment Adenocarcinoma Internal medicine medicine Humans Survival rate business.industry Esophageal disease Background data Cancer Middle Aged Esophageal cancer medicine.disease Surgery Esophagectomy Survival Rate Lymphatic Metastasis Carcinoma Squamous Cell Lymph Node Excision Female Lymphadenectomy business |
| Zdroj: | Annals of Surgery. 251:46-50 |
| ISSN: | 0003-4932 |
| DOI: | 10.1097/sla.0b013e3181b2f6ee |
| Popis: | Using Worldwide Esophageal Cancer Collaboration data, we sought to (1) characterize the relationship between survival and extent of lymphadenectomy, and (2) from this, define optimum lymphadenectomy.What constitutes optimum lymphadenectomy to maximize survival is controversial because of variable goals, analytic methodology, and generalizability of the underpinning data.A total of 4627 patients who had esophagectomy alone for esophageal cancer were identified from the Worldwide Esophageal Cancer Collaboration database. Patient-specific risk-adjusted survival was estimated using random survival forests. Risk-adjusted 5-year survival was averaged for each number of lymph nodes resected and its relation to cancer characteristics explored. Optimum number of nodes that should be resected to maximize 5-year survival was determined by random forest multivariable regression.For pN0M0 moderately and poorly differentiated cancers, and all node-positive (pN+) cancers, 5-year survival improved with increasing extent of lymphadenectomy. In pN0M0 cancers, no optimum lymphadenectomy was defined for pTis; optimum lymphadenectomy was 10 to 12 nodes for pT1, 15 to 22 for pT2, and 31 to 42 for pT3/T4, depending on histopathologic cell type. In pN+M0 cancers and 1 to 6 nodes positive, optimum lymphadenectomy was 10 for pT1, 15 for pT2, and 29 to 50 for pT3/T4.Greater extent of lymphadenectomy was associated with increased survival for all patients with esophageal cancer except at the extremes (TisN0M0 andor=7 regional lymph nodes positive for cancer) and well-differentiated pN0M0 cancer. Maximum 5-year survival is modulated by T classification: resecting 10 nodes for pT1, 20 for pT2, andor=30 for pT3/T4 is recommended. |
| Databáze: | OpenAIRE |
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