Impact of the number of resected lymph nodes on survival after preoperative radiotherapy for esophageal cancer
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San-Gang Wu1,*, Zhao-Qiang Zhang2,*, Wen-Ming Liu3,*, Zhen-Yu He4, Feng-Yan Li4, Huan-Xin Lin4, Jia-Yuan Sun4, Hui Lin5, Qun Li4
1Department of Radiation Oncology, the First Affiliated Hospital of Xiamen University, Xiamen 361003, People’s Republic of China
2Eye Institute of Xiamen University, Fujian Provincial Key Laboratory of Ophthalmology and Visual Science, Medical College of Xiamen University, Xiamen 361003, People’s Republic of China
3Department of Gastroenterology, Zhongshan Hospital of Xiamen University, Xiamen 361003, People’s Republic of China
4Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Department of Radiation Oncology, Collaborative Innovation Center of Cancer Medicine, Guangzhou 510060, People’s Republic of China
5Department of Cardiovascular and Thoracic Surgery, The People’s Hospital of Guangxi Zhuang Autonomous Region, Nanning 530021, People’s Republic of China
*These authors contributed equally to this work
Hui Lin, e-mail: [email protected]
Qun Li, e-mail: [email protected]
Keywords: esophageal cancer, lymph nodes, preoperative radiotherapy, survival, SEER
Received: October 29, 2015 Accepted: February 24, 2016 Published: March 16, 2016
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.
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