Impact of Dissected Lymph Node Count and Positive Lymph Node Ratio Following Esophagectomy on Long-Term Outcomes in Esophageal Cancer: A Systematic Review and Meta-Analysis.

Eisuke Booka, Hiroya Takeuchi, Yuki Sakai, Ryoma Haneda, Wataru Soneda, Tomohiro Murakami, Tomohiro Matsumoto, Yoshifumi Morita, Hirotoshi Kikuchi, Yoshihiro Hiramatsu, Mark K Ferguson
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Abstract

Objective: This meta-analysis evaluated how the number of lymph nodes dissected (LND) and the positive lymph node ratio (LNR) following esophagectomy influence long-term outcomes in esophageal cancer.

Background: Esophagectomy is a critical treatment for esophageal cancer, but the optimal extent of lymphadenectomy remains debated, especially in the era of modern neoadjuvant protocols.

Methods: A systematic electronic search of Embase, Medline, and the Cochrane Library was performed for studies published between 2000 and 2024. Included studies assess overall survival (OS) in patients with esophageal cancer undergoing esophagectomy with lymphadenectomy, comparing groups with high and low LND and LNR. A subset analysis examined outcomes in patients receiving neoadjuvant therapy.

Results: In total, 18 and 19 articles were included in the LND and LNR meta-analyses, respectively. High LND and low LNR were associated with improved OS [LND: hazard ratio (HR) = 0.75, 95% confidence interval (CI) = 0.67-0.85, P < 0.01; LNR: HR = 0.39, 95% CI = 0.33-0.47, P < 0.001]. Subset analysis revealed that these survival benefits persisted in patients who received neoadjuvant therapy (LND: HR = 0.56, 95% CI = 0.34-0.93, P = 0.01; LNR: HR = 0.24, 95% CI = 0.15-0.39, P < 0.001).

Conclusions: These findings highlight the prognostic importance of high LND and low LNR in improving OS following esophagectomy, regardless of neoadjuvant therapy. Extensive lymphadenectomy may enhance survival, and LNR provides a valuable prognostic tool for guiding postoperative treatment decisions.

食管癌切除术后清扫淋巴结计数和阳性淋巴结比例对食管癌长期预后的影响:系统回顾和荟萃分析
目的:本荟萃分析评估食管切除术后淋巴结清扫数(LND)和淋巴结阳性比例(LNR)对食管癌长期预后的影响。背景:食管切除术是食管癌的重要治疗方法,但淋巴结切除术的最佳范围仍存在争议,特别是在现代新辅助方案的时代。方法:对Embase、Medline和Cochrane图书馆进行系统的电子检索,检索2000年至2024年间发表的研究。纳入的研究评估食管癌患者行食管切除术合并淋巴结切除术的总生存期(OS),比较高、低LND和LNR组。一项亚组分析检查了接受新辅助治疗的患者的预后。结果:共有18篇和19篇文章分别被纳入LND和LNR荟萃分析。LND高、LNR低与OS改善相关[LND:风险比(HR) = 0.75, 95%可信区间(CI) = 0.67 ~ 0.85, P < 0.01;Lnr: hr = 0.39, 95% ci = 0.33 ~ 0.47, p < 0.001]。亚群分析显示,接受新辅助治疗的患者的生存获益持续存在(LND: HR = 0.56, 95% CI = 0.34-0.93, P = 0.01;Lnr: hr = 0.24, 95% ci = 0.15-0.39, p < 0.001)。结论:这些发现强调了高LND和低LNR对改善食管切除术后OS的预后重要性,无论新辅助治疗如何。广泛淋巴结切除术可提高生存率,LNR为指导术后治疗决策提供了有价值的预后工具。
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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