Prognostic value of the number of lymph nodes resected in patients with lymph-node-negative esophageal squamous cell carcinoma. 2020

Guoping Xu, and Ming Jin, and Yingjie Shao, and Yuan Chen, and Zhonghua Ning
Department of Radiation Oncology, The Third Affiliated Hospital of Soochow University Changzhou, China.

No consensus has been achieved regarding the optimal extent of lymph node (LN) dissection for node-negative ESCC patients. This study aimed to determine the optimal extent of LN dissection for node-negative ESCC patients. We retrospectively reviewed 481 ESCC patients with node-negative resection and no preoperative therapy. Overall survival (OS) was evaluated by the log-rank test and multivariate Cox regression. The 5-year OS was 51.7% and 64.7% for patients with 1-5 and ≥6 negative LNs resected, respectively (P<0.001). However, there was no significant survival difference between patients with 6-12 negative LNs resected and patients with over 12 negative LNs resected (P=0.205). Multivariate analysis indicated that the negative LN count was independently associated with better survival. In the subgroup analysis, no optimum lymphadenectomy was defined for T1; the minimum number of LNs that needed to be resected was 6 nodes for T2 and 7 nodes for T3. No survival benefit was observed when extensive lymphadenectomy was performed. The nomogram, including the number of LNs examined, T stage, and histologic differentiation, had more predictive power than TNM staging. The results of our study suggest that ESCC patients with LN-negative tumors should have at least 6 LNs examined for T2 and 7 LNs for T3, but extensive lymphadenectomy is not recommended. The nomogram, including the number of LNs examined, T stage, and histologic differentiation, is a useful clinical tool.

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