Abstract
To assess the impact of the number of resected lymph nodes (RLNs) for survival in esophageal cancer (EC) patients treated with preoperative radiotherapy and cancer-directed surgery. The Surveillance Epidemiology and End Results (SEER) database was queried to identify EC patients treated from 1988 to 2012 who had complete data on the number of positive lymph nodes and number of RLNs. Kaplan–Meier survival analysis and Cox regression proportional hazard methods were used to determine factors that significantly impact cause-specific survival (CSS) and overall survival (OS). There were a total of 3,159 patients who received preoperative radiotherapy and cancer-directed surgery. The median number of RLNs was 10 in both patients who received and did not receive preoperative radiotherapy (P = 0.332). Cox regression univariate and multivariate analysis showed that RLN count was a significant prognostic factor for CSS and OS. Patients with 11–71 RLNs had better CSS (hazard ratio [HR] = 0.694, 95% confidence interval [CI]: 0.603–0.799, P < 0.001) and OS (HR = 0.724, 95% CI: 0.636–0.824, P < 0.001) than patients with 1–10 RLNs. The 5-year CSS rates were 39.1% and 44.8% in patients with 1–10 RLNs and 11–71 RLNs, respectively (P < 0.001). The 5-year OS rates were 33.7% and 39.9% in patients with 1–10 RLNs and 11–71 RLNs, respectively (P < 0.001). A higher number of RLNs was associated with better survival by tumor stage and nodal stage (all P < 0.05). RLN count is an independent prognostic factor in EC patients who undergo preoperative radiotherapy and cancer-directed surgery.
Highlights
The randomized Chemoradiotherapy for Oesophageal Cancer Followed by Surgery Study (CROSS) revealed the efficacy of neoadjuvant chemoradiotherapy combined with surgery was superior to that of surgery alone [1, 2]
This study investigated the impact of the number of resected lymph nodes (RLNs) on survival after preoperative radiotherapy and cancer-directed surgery for esophageal cancer (EC) patients using the Surveillance Epidemiology and End Results (SEER) database
The results showed that the number of RLNs was an independent prognostic factor for cause-specific survival (CSS) and overall survival (OS), a higher number of RLNs was associated with better survival
Summary
The randomized Chemoradiotherapy for Oesophageal Cancer Followed by Surgery Study (CROSS) revealed the efficacy of neoadjuvant chemoradiotherapy (nCRT) combined with surgery was superior to that of surgery alone [1, 2]. Even though the CROSS study found www.impactjournals.com/oncotarget that the number of resected lymph nodes (RLNs) had no influence on survival of EC patients [5], the prognostic and therapeutic value of lymphadenectomy in EC patients who receive neoadjuvant therapy remains controversial [6,7,8,9]. In this study we investigate the prognostic value of the number of RLNs in the EC patients who received preoperative radiotherapy using a population-based analysis of the SEER database.
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