Impact of negative lymph node removal on survival in esophageal cancer: a systematic review and meta-analysis.

IF 1.6 3区医学 Q2 SURGERY

BMC Surgery Pub Date : 2025-03-28 DOI:10.1186/s12893-025-02858-0

Mansour Bahardoust, Seyedmohammadreza Torabi, Danyal Yarahmadi, Mohammad Mahdi Kakoienejad, Fatemeh Abbasi, Mohammadsadra Shamohammadi, Meisam Haghmoradi, Babak Goodarzy, Adnan Tizmaghz

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Abstract

Background: Recent studies have reported that a high number of negative lymph nodes (NLNs) removed can be associated with improved survival in esophageal cancer( EC) after surgery; however, the effect size of a high number of removed NLNs on survival rates has been reported to vary, which may be due to the small sample size of early studies. This meta-analysis aimed to evaluate the effect of the high number of NLNs removed on the survival rate of patients with EC after surgery.

Methods: We searched PubMed, Embase, Scopus, Web of Science, and Google Scholar databases with relevant Mesh terms to find studies that investigated the effect of the number of NLNs resected on the survival of EC patients after surgery until February 17, 2025. This systematic review was conducted based on the PRISMA 2020 checklist. Cochran's I² was used to evaluate heterogeneity between studies. Publication bias was evaluated using the Egger test. Heterogeneity between studies was controlled by meta-regression. Finally, eight studies involving 5,521 EC patients were included.

Results: The survival rate in patients whose number of removed NLNs ≥ 19 was significantly better than those with removed NLNs < 19 (HR: 0.88, 95% CI: 0.81, 0.95, I² = 84.4). Subgroup analysis of 8 studies showed that the protective effect of the high number of removed NLNs) ≥ 19 (was greater in adenocarcinoma patients than in SCC (Pooled HR: 0.63 vs. 0.88).

Conclusion: The high number of NLNs removed (≥ 19) during surgery was associated with improved survival after surgery, especially in patients with adenocarcinoma. Removing ≥ 19 NLNs significantly improves survival in EC patients, particularly those with adenocarcinoma. This threshold should be incorporated into surgical guidelines.

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背景：最近有研究报告称，切除大量阴性淋巴结（NLNs）可提高食管癌（EC）术后生存率；然而，据报道，切除大量NLNs对生存率的影响大小不一，这可能是由于早期研究的样本量较小。本荟萃分析旨在评估大量切除 NLN 对 EC 患者术后存活率的影响：我们在PubMed、Embase、Scopus、Web of Science和Google Scholar数据库中检索了相关的Mesh术语，以找到截至2025年2月17日调查NLN切除数量对EC患者术后生存率影响的研究。本系统性综述根据 PRISMA 2020 清单进行。采用 Cochran's I2 评估研究间的异质性。采用 Egger 检验评估发表偏倚。通过元回归控制研究之间的异质性。最后，纳入了涉及5521名EC患者的8项研究：结果：移除NLN数量≥19个的患者生存率明显优于移除NLN数量≥19个的患者（2 = 84.4）。对 8 项研究进行的亚组分析表明，NLNs 清除数量多≥ 19（对腺癌患者的保护作用大于对 SCC 患者的保护作用（汇总 HR：0.63 vs. 0.88）：结论：手术中切除大量 NLNs（≥ 19 个）与术后生存率的提高有关，尤其是在腺癌患者中。切除≥19个NLN可显著提高EC患者的生存率，尤其是腺癌患者。这一阈值应纳入手术指南。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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