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Article: Optimum lymphadenectomy for esophageal cancer

TitleOptimum lymphadenectomy for esophageal cancer
Authors
Issue Date2010
PublisherLippincott Williams & Wilkins. The Journal's web site is located at http://www.annalsofsurgery.com
Citation
Annals Of Surgery, 2010, v. 251 n. 1, p. 46-50 How to Cite?
AbstractOBJECTIVE: Using Worldwide Esophageal Cancer Collaboration data, we sought to (1) characterize the relationship between survival and extent of lymphadenectomy, and (2) from this, define optimum lymphadenectomy. SUMMARY BACKGROUND DATA: What constitutes optimum lymphadenectomy to maximize survival is controversial because of variable goals, analytic methodology, and generalizability of the underpinning data. METHODS: A total of 4627 patients who had esophagectomy alone for esophageal cancer were identified from the Worldwide Esophageal Cancer Collaboration database. Patient-specific risk-adjusted survival was estimated using random survival forests. Risk-adjusted 5-year survival was averaged for each number of lymph nodes resected and its relation to cancer characteristics explored. Optimum number of nodes that should be resected to maximize 5-year survival was determined by random forest multivariable regression. RESULTS: For pN0M0 moderately and poorly differentiated cancers, and all node-positive (pN+) cancers, 5-year survival improved with increasing extent of lymphadenectomy. In pN0M0 cancers, no optimum lymphadenectomy was defined for pTis; optimum lymphadenectomy was 10 to 12 nodes for pT1, 15 to 22 for pT2, and 31 to 42 for pT3/T4, depending on histopathologic cell type. In pN+M0 cancers and 1 to 6 nodes positive, optimum lymphadenectomy was 10 for pT1, 15 for pT2, and 29 to 50 for pT3/T4. CONCLUSIONS: Greater extent of lymphadenectomy was associated with increased survival for all patients with esophageal cancer except at the extremes (TisN0M0 and ≥7 regional lymph nodes positive for cancer) and well-differentiated pN0M0 cancer. Maximum 5-year survival is modulated by T classification: resecting 10 nodes for pT1, 20 for pT2, and ≥30 for pT3/T4 is recommended. Copyright © 2009 by Lippincott Williams & Wilkins.
Persistent Identifierhttp://hdl.handle.net/10722/123991
ISSN
2015 Impact Factor: 8.569
2015 SCImago Journal Rankings: 4.503
ISI Accession Number ID
Funding AgencyGrant Number
Cleveland Clinic Foundation
Daniel and Karen Lee Endowed Chair in Thoracic Surgery
Kenneth Gee and Paula Shaw, PhD, Chair in Heart Research
Funding Information:

Supported by The Cleveland Clinic Foundation, the Daniel and Karen Lee Endowed Chair in Thoracic Surgery (to T.W.R.), and the Kenneth Gee and Paula Shaw, PhD, Chair in Heart Research (to E.H.B.).

References

 

DC FieldValueLanguage
dc.contributor.authorRizk, NPen_HK
dc.contributor.authorIshwaran, Hen_HK
dc.contributor.authorRice, TWen_HK
dc.contributor.authorChen, LQen_HK
dc.contributor.authorSchipper, PHen_HK
dc.contributor.authorKesler, KAen_HK
dc.contributor.authorLaw, Sen_HK
dc.contributor.authorLerut, TEMRen_HK
dc.contributor.authorReed, CEen_HK
dc.contributor.authorSalo, JAen_HK
dc.contributor.authorScott, WJen_HK
dc.contributor.authorHofstetter, WLen_HK
dc.contributor.authorWatson, TJen_HK
dc.contributor.authorAllen, MSen_HK
dc.contributor.authorRusch, VWen_HK
dc.contributor.authorBlackstone, EHen_HK
dc.date.accessioned2010-10-15T08:08:53Z-
dc.date.available2010-10-15T08:08:53Z-
dc.date.issued2010en_HK
dc.identifier.citationAnnals Of Surgery, 2010, v. 251 n. 1, p. 46-50en_HK
dc.identifier.issn0003-4932en_HK
dc.identifier.urihttp://hdl.handle.net/10722/123991-
dc.description.abstractOBJECTIVE: Using Worldwide Esophageal Cancer Collaboration data, we sought to (1) characterize the relationship between survival and extent of lymphadenectomy, and (2) from this, define optimum lymphadenectomy. SUMMARY BACKGROUND DATA: What constitutes optimum lymphadenectomy to maximize survival is controversial because of variable goals, analytic methodology, and generalizability of the underpinning data. METHODS: A total of 4627 patients who had esophagectomy alone for esophageal cancer were identified from the Worldwide Esophageal Cancer Collaboration database. Patient-specific risk-adjusted survival was estimated using random survival forests. Risk-adjusted 5-year survival was averaged for each number of lymph nodes resected and its relation to cancer characteristics explored. Optimum number of nodes that should be resected to maximize 5-year survival was determined by random forest multivariable regression. RESULTS: For pN0M0 moderately and poorly differentiated cancers, and all node-positive (pN+) cancers, 5-year survival improved with increasing extent of lymphadenectomy. In pN0M0 cancers, no optimum lymphadenectomy was defined for pTis; optimum lymphadenectomy was 10 to 12 nodes for pT1, 15 to 22 for pT2, and 31 to 42 for pT3/T4, depending on histopathologic cell type. In pN+M0 cancers and 1 to 6 nodes positive, optimum lymphadenectomy was 10 for pT1, 15 for pT2, and 29 to 50 for pT3/T4. CONCLUSIONS: Greater extent of lymphadenectomy was associated with increased survival for all patients with esophageal cancer except at the extremes (TisN0M0 and ≥7 regional lymph nodes positive for cancer) and well-differentiated pN0M0 cancer. Maximum 5-year survival is modulated by T classification: resecting 10 nodes for pT1, 20 for pT2, and ≥30 for pT3/T4 is recommended. Copyright © 2009 by Lippincott Williams & Wilkins.en_HK
dc.languageeng-
dc.publisherLippincott Williams & Wilkins. The Journal's web site is located at http://www.annalsofsurgery.comen_HK
dc.relation.ispartofAnnals of Surgeryen_HK
dc.subject.meshAdenocarcinoma - pathology - surgery-
dc.subject.meshCarcinoma, Squamous Cell - pathology - surgery-
dc.subject.meshEsophageal Neoplasms - mortality - pathology - surgery-
dc.subject.meshEsophagectomy-
dc.subject.meshLymph Node Excision - methods-
dc.titleOptimum lymphadenectomy for esophageal canceren_HK
dc.typeArticleen_HK
dc.identifier.openurlhttp://library.hku.hk:4550/resserv?sid=HKU:IR&issn=0003-4932&volume=251&issue=1&spage=46&epage=50&date=2010&atitle=Optimum+lymphadenectomy+for+esophageal+cancer-
dc.identifier.emailLaw, S: slaw@hku.hken_HK
dc.identifier.authorityLaw, S=rp00437en_HK
dc.description.naturelink_to_subscribed_fulltext-
dc.identifier.doi10.1097/SLA.0b013e3181b2f6eeen_HK
dc.identifier.pmid20032718-
dc.identifier.scopuseid_2-s2.0-74049162396en_HK
dc.identifier.hkuros172558-
dc.relation.referenceshttp://www.scopus.com/mlt/select.url?eid=2-s2.0-74049162396&selection=ref&src=s&origin=recordpageen_HK
dc.identifier.volume251en_HK
dc.identifier.issue1en_HK
dc.identifier.spage46en_HK
dc.identifier.epage50en_HK
dc.identifier.eissn1528-1140-
dc.identifier.isiWOS:000273203600007-
dc.publisher.placeUnited Statesen_HK
dc.identifier.scopusauthoridRizk, NP=7006537355en_HK
dc.identifier.scopusauthoridIshwaran, H=7003266763en_HK
dc.identifier.scopusauthoridRice, TW=7201893679en_HK
dc.identifier.scopusauthoridChen, LQ=7409434941en_HK
dc.identifier.scopusauthoridSchipper, PH=7004066850en_HK
dc.identifier.scopusauthoridKesler, KA=16750345400en_HK
dc.identifier.scopusauthoridLaw, S=7202241293en_HK
dc.identifier.scopusauthoridLerut, TEMR=20834801600en_HK
dc.identifier.scopusauthoridReed, CE=35404275400en_HK
dc.identifier.scopusauthoridSalo, JA=35433761500en_HK
dc.identifier.scopusauthoridScott, WJ=7403054180en_HK
dc.identifier.scopusauthoridHofstetter, WL=7005630907en_HK
dc.identifier.scopusauthoridWatson, TJ=35514467100en_HK
dc.identifier.scopusauthoridAllen, MS=26321296800en_HK
dc.identifier.scopusauthoridRusch, VW=7005656070en_HK
dc.identifier.scopusauthoridBlackstone, EH=36039976900en_HK

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