The optimal number of lymph node dissections in three-field lymphadenectomy for esophageal squamous cell carcinoma: a large retrospective study.

Abstract

Background: Currently, there is no consensus on the optimal number of lymph node dissections (LNDs) in three-field lymphadenectomy for esophageal squamous cell carcinoma (ESCC). This study aimed to explore the relationship between the LND count and overall survival (OS) in ESCC patients to determine the optimal number of LNDs that confer a survival benefit.

Methods: A retrospective analysis was conducted on ESCC patients who underwent three-field lymphadenectomy at Fujian Cancer Hospital from February 2004 to January 2018. The optimal LND number was determined using X-Tile software. Kaplan‒Meier survival curves and Cox regression analyses were used to evaluate the relationship between LND count and OS.

Results: A total of 1053 ESCC patients who underwent three-field lymphadenectomy were included in this study (median age 58 years [IQR: 52-65], 781 males [74.2%]). Using X-Tile software, 27 was identified as the optimal cutoff value for the number of LNDs. The 5-year OS for the > 27 LNDs group was significantly better than that for the ≤ 27 LNDs group (67.8% vs. 59.8%, P = 0.042). Multivariate Cox regression analysis confirmed that LND count (≤ 27 and > 27) was an independent protective factor for OS (HR = 0.724; P = 0.004). Stratified analysis on the basis of TNM stage revealed that in patients with T3-4N0M0 disease (HR = 0.412; P = 0.001) and T1-2 N + M0 disease (HR = 0.503; P = 0.025), a greater number of dissected lymph nodes was closely associated with a survival benefit.

Conclusion: For ESCC patients undergoing three-field lymphadenectomy, dissecting more than 27 lymph nodes is associated with better prognosis, especially for patients with T3-4N0M0 and T1-2 N + M0 stages.