Achieving adequate lymph node dissection in treating esophageal squamous cell carcinomas by radical lymphadenectomy: Beyond the scope of numbers of harvested lymph nodes

Lin,Zheng; Chen,Weilin; Chen,Yuanmei; Peng,Xiane; Yan,Siyou; He,Fei; Fu,Rong; Jiang,Yixian; Hu,Zhijian

doi:10.3892/ol.2019.10465

Achieving adequate lymph node dissection in treating esophageal squamous cell carcinomas by radical lymphadenectomy: Beyond the scope of numbers of harvested lymph nodes

Authors:
- Zheng Lin
- Weilin Chen
- Yuanmei Chen
- Xiane Peng
- Siyou Yan
- Fei He
- Rong Fu
- Yixian Jiang
- Zhijian Hu
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Affiliations: Department of Epidemiology and Health Statistics, Fujian Provincial Key Laboratory of Environment Factors and Cancer, School of Public Health, Fujian Medical University, Fuzhou, Fujian 350108, P.R. China, Department of Radiation Oncology, Affiliated Zhangzhou Hospital of Fujian Medical University, Zhangzhou, Fujian 363000, P.R. China, Department of Thoracic Surgery, Fujian Provincial Cancer Hospital, Fuzhou, Fujian 350014, P.R. China
Published online on: June 12, 2019 https://doi.org/10.3892/ol.2019.10465
Pages: 1617-1630
Copyright: © Lin et al. This is an open access article distributed under the terms of Creative Commons Attribution License.

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Abstract

Previous studies have recommended harvesting a large number of lymph nodes (LNs) to improve the survival of patients with esophageal squamous cell carcinoma (ESCC). These studies or clinical guidelines focus on the total harvested LNs during lymphadenectomy; however, the extent of LN dissection (LND) required in patients with ESCCs remains controversial. The present study proposed a novel individualized adequate LND (ALND) strategy to compliment current guidelines to improve individualized therapeutic efficacy. For N0 cases, ALND was defined as an LN harvest of >55% of the LNs from nodal zones adjacent to the tumor location; and for N+ cases, ALND was defined as 8, 8, 8, 8 or 16 LNs dissected from the involved cervical, upper, middle, lower and celiac zones, respectively. Retrospective analysis of the ESCC cohort revealed that the ALND was associated with improved patient survival [hazard ratio (HR)=0.45 and 95% CI=0.30‑0.66)]. Stratified analyses revealed that the protective role of ALND was prominent, with the exception of higher pN+ staged (pN2‑3) cases (HR=0.52, 95% CI=0.23‑1.18). Furthermore, ALND was associated with improved survival in local diseases (T1‑3/N0‑1; HR=0.50, 95% CI=0.30‑0.84) and locally advanced diseases (T4/Nany or T1‑3/N2‑3; HR=0.32, 95% CI=0.15‑0.68). These findings suggested that the proposed ALND strategy may effectively improve the survival of patients with ESCC.

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