Postoperative survival effect of the number of examined lymph nodes on esophageal squamous cell carcinoma with pathological stage T1-3N0M0

Abstract

Background: The postoperative survival effect of the number of examined lymph nodes on patients of R0-resected esophageal squamous cell carcinoma with pathological stage T1-3N0M0 is still unclear.

Methods: Patients diagnosed with pathological stage T1-3N0M0 esophageal squamous cell carcinoma from two cancer databases-our cancer center (N = 707), and Surveillance Epidemiology and End Results (N = 151). The primary clinical endpoint was overall survival. The X-tile software was used to determine the optimal cutoff value of the number of examined lymph nodes, and propensity score matching was conducted to reduce selection bias according to the results of X-tile software. The cohort of 151 patients from another database was used for validation.

Results: X-tile software provided an optimal cutoff value of 15 examined lymph nodes based on 707 patients, and 231 pairs of matched patients were included. In the unmatched cohort, Cox proportional hazard regression analysis revealed better overall survival in patients with more than 15 examined lymph nodes (adjusted hazard ratio, 0.566, 95% confidence interval, 0.445-0.720; p < 0.001) compared with patients with 15 or fewer examined lymph nodes. In the validation cohort, patients with more than 15 examined lymph nodes also had better overall survival (adjusted hazard ratio 0.665, p = 0.047).

Conclusions: The number of examined lymph nodes is a significant prognostic factor in esophageal squamous cell carcinoma patients with pathological stage T1-3N0M0, and more than 15 examined lymph nodes are associated with better overall survival. Although the difference is not significant, the survival curve of patients with examined lymph nodes > 30 is better than those with examined lymph nodes 15-30. We believe that the number of examined lymph nodes can provide prognostic guidance for those patients, and the more examined lymph nodes cause lesser occult lymph nodes metastasis and lead to a better prognosis. Therefore, surgeons and pathologists should try to examine as many lymph nodes as possible to evaluate the pathological stage precisely. However, we need more validation from other studies.

Keywords: Esophageal squamous cell carcinoma; Lymph node; Overall survival; SEER; Stage T1–3N0M0.

Fig. 1

The diagram of the patient screening process in the SYSUCC and SEER database (SYSUCC Sun Yat-sen University Cancer Center, SEER Surveillance Epidemiology and End Results, AJCC American Joint Committee on Cancer Staging Manual)

Fig. 2

The distribution of lymph-node count in Sun Yat-sen University Cancer Center (A) and Surveillance Epidemiology and End Results database (B)

Fig. 3

Overall survival curve for esophageal squamous cell cancer patients with stage T1–3N0M0 according to the number of examined lymph nodes in the unmatched cohort of Sun Yat-sen University Cancer Center (A), matched patients of Sun Yat-sen University Cancer Center (B), and Surveillance Epidemiology and End Results database (C)

Fig. 4

Overall survival curve for esophageal squamous cell cancer patients with stage T1–3N0M0 according to the number of examined lymph nodes

Fig. 5

Overall survival curve for esophageal squamous cell cancer patients with stage T1–3N0M0 according to the number of examined lymph nodes in the cohort of pathological stage T1 (A), T2 (B) and T3 (C)