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Ann Surg. 2008 Oct;248(4):549-56. doi: 10.1097/SLA.0b013e318188c474.

The number of lymph nodes removed predicts survival in esophageal cancer: an international study on the impact of extent of surgical resection.

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  • 1Department of Surgery, Keck School of Medicine at the University of Southern California, Los Angeles, CA, USA.

Abstract

OBJECTIVE:

Surveillance, Epidemiology and End Results (SEER) data indicate that number of lymph nodes removed impacts survival in gastric cancer. Our aim was to study this relationship in esophageal cancer.

METHODS:

The study population included 2303 esophageal cancer patients (1381 adenocarcinoma, 922 squamous) from 9 international centers that had R0 esophagectomy prior to 2002 and were followed at regular intervals for 5 years or until death. Patients treated with neoadjuvant or adjuvant therapy were excluded.

RESULTS:

Operations consisted of esophagectomy with (1700) and without (603) thoracotomy. Median number of nodes removed was 17 (IQR10-29). There were 508 patients with stage I, 853 stage II, and 942 stage III. Five-year survival was 40%. Cox regression analysis showed that the number of lymph nodes removed was an independent predictor of survival (P < 0.0001). The optimal threshold predicted by Cox regression for this survival benefit was removal of a minimum of 23 nodes. Other independent predictors of survival were the number of involved nodes, depth of invasion, presence of nodal metastasis, and cell type.

CONCLUSIONS:

The number of lymph nodes removed is an independent predictor of survival after esophagectomy for cancer. To maximize this survival benefit a minimum of 23 regional lymph nodes must be removed.

PMID:
18936567
[PubMed - indexed for MEDLINE]
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