医学
淋巴结切除术
食管切除术
四分位间距
新辅助治疗
淋巴结
外科肿瘤学
外科
放化疗
比例危险模型
内科学
淋巴
食管癌
危险系数
总体生存率
癌症
置信区间
病理
乳腺癌
作者
Aaldert K. Talsma,Joël Shapiro,Caspar W. N. Looman,Pieter van Hagen,Ewout W. Steyerberg,Ate van der Gaast,Mark I. van Berge Henegouwen,Bas P. L. Wijnhoven,J. Jan B. van Lanschot
出处
期刊:Annals of Surgery
[Ovid Technologies (Wolters Kluwer)]
日期:2014-11-01
卷期号:260 (5): 786-793
被引量:134
标识
DOI:10.1097/sla.0000000000000965
摘要
In Brief Objectives: We aimed to examine the association between total number of resected nodes and survival in patients after esophagectomy with and without nCRT. Background: Most studies concerning the potentially positive effect of extended lymphadenectomy on survival have been performed in patients who underwent surgery alone. As nCRT is known to frequently “sterilize” regional nodes, it is unclear whether extended lymphadenectomy after nCRT is still useful. Methods: Patients from the randomized CROSS-trial who completed the entire protocol (ie, surgery alone or chemoradiotherapy + surgery) were included. With Cox regression models, we compared the impact of number of resected nodes as well as resected positive nodes on survival in both groups. Results: One hundred sixty-one patients underwent surgery alone, and 159 patients received multimodality treatment. The median (interquartile range) number of resected nodes was 18 (12–27) and 14 (9–21), with 2 (1–6) and 0 (0–1) resected positive nodes, respectively. Persistent lymph node positivity after nCRT had a greater negative prognostic impact on survival as compared with lymph node positivity after surgery alone. The total number of resected nodes was significantly associated with survival for patients in the surgery-alone arm (hazard ratio per 10 additionally resected nodes, 0.76; P = 0.007), but not in the multimodality arm (hazard ratio 1.00; P = 0.98). Conclusions: The number of resected nodes had a prognostic impact on survival in patients after surgery alone, but its therapeutic value is still controversial. After nCRT, the number of resected nodes was not associated with survival. These data question the indication for maximization of lymphadenectomy after nCRT. Extended lymphadenectomy during surgery potentially has prognostic and therapeutic impact on survival. In the present study, the prognostic impact was clear for patients who underwent surgery alone, but the therapeutic impact remained questionable. After neoadjuvant chemoradiotherapy (nCRT), the number of resected nodes was not associated with survival.
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