Abstract
A negative lymph node (NLN) may represent a stronger predictor for the overall survival (OS) rate of patients with esophageal squamous cell carcinoma (ESCC), when compared with a positive LN (PLN). The present study aimed to investigate which LN station, containing the NLN, was associated with OS rate. A retrospective review was conducted in 216 patients with ESCC and a forward stepwise Cox regression model analysis was used to assess the relationship between clinical parameters and OS rate. Patients were divided into subgroups according to the status of the LN at station 108. Survival analysis was performed using the Kaplan-Meier method. The ratio of albumin-to-globulin (AGR), and of lymphocytes to neutrophil granulocytes (LNR) in the subgroups were also investigated. Overall, 105p (the PLN number at station 105), 108p, 109p and 7p were confirmed to be risk factors for OS rate (all P<0.05). Conversely, 108n (the NLN number at station 108) was identified as a protective factor for OS rate [hazard ratio (HR) 0.457, P=0.001]. Survival analysis demonstrated that patients with an NLN identified at the station 108 had an improved OS rate compared with those with a PLN identified at station 108 (P=0.006). Patients with only an NLN identified at station 108 had the best OS rate among all the sub-groups examined, and the AGR of this group of patients was higher than those of the other groups. The LN status at station 108 may indicate the prognosis of patients with ESCC, and an NLN may reflect the reaction of the immune system to tumor metastasis in these patients.
Highlights
Esophageal squamous cell carcinoma (ESCC) is the principal pathological subtype of thoracic esophageal cancer reported in Asia in over the previous 30 years [1,2,3]
Research had proven that radiotherapy serves a key role in decreasing the probability of local tumor recurrence following surgery, and in prolonging overall survival (OS) rate; there was an issue, in that the design of treatment plans for radiotherapy was based on the metastasis pattern of positive LN (PLN), without considering the effect of negative LN (NLN) on the prognosis of patients [10,11]
The extent of lymphadenectomy is insufficient if only PLN are removed in ESCC
Summary
Esophageal squamous cell carcinoma (ESCC) is the principal pathological subtype of thoracic esophageal cancer reported in Asia in over the previous 30 years [1,2,3]. The number of negative LN (NLN) identified pathologically following surgery has been considered to be an even stronger predictor of OS rate in patients with ESCC [9]. To the best of our knowledge, it is unclear which LN station containing the NLN served a key role in the prognosis of patients with ESCC; improving the presently available knowledge would be helpful for the design of treatment plans for postoperative radiotherapy. Research had proven that radiotherapy serves a key role in decreasing the probability of local tumor recurrence following surgery, and in prolonging OS rate; there was an issue, in that the design of treatment plans for radiotherapy was based on the metastasis pattern of PLN, without considering the effect of NLN on the prognosis of patients [10,11]. The present study aimed to investigate in which LN station the presence of NLN had a great impact on OS rate, for patients with middle and lower thoracic ESCC
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