The Relationship Between Lymph Node Ratio and Survival Benefit With Adjuvant Chemotherapy in Node-positive Esophageal Adenocarcinoma.
Journal
Annals of surgery
ISSN: 1528-1140
Titre abrégé: Ann Surg
Pays: United States
ID NLM: 0372354
Informations de publication
Date de publication:
01 03 2022
01 03 2022
Historique:
pubmed:
11
7
2020
medline:
19
2
2022
entrez:
11
7
2020
Statut:
ppublish
Résumé
We hypothesized that the ratio of positive lymph nodes to total assessed lymph nodes (LNR) is an indicator of cancer burden in esophageal adenocarcinoma and may identify patients who may most benefit from AC. The aim of this study was to discern whether there is a threshold LNR above which AC is associated with a survival benefit in this population. The 2004-2015 National Cancer Database was queried for patients who underwent upfront, complete resection of pT1-4N1-3M0 esophageal adenocarcinoma. The primary outcome, overall survival, was examined using multivariable Cox proportional hazards models employing an interaction term between LNR and AC. A total of 1733 patients were included: 811 (47%) did not receive AC whereas 922 (53%) did. The median LNR was 20% (interquartile range 9-40). In a multivariable Cox model, the interaction term between LNR and receipt of AC was significant (P = 0.01). A plot of the interaction demonstrated that AC was associated with improved survival beyond a LNR of about 10%-12%. In a sensitivity analysis, the receipt of AC was not associated with improved survival in patients with LNR <12% (hazard ratio 1.02; 95% confidence interval 0.72-1.44) but was associated with improved survival in those with LNR ≥12% (hazard ratio 0.65; 95% confidence interval 0.50-0.79). In this study of patients with upfront, complete resection of node-positive esophageal adenocarcinoma, AC was associated with improved survival for LNR ≥12%. LNR may be used as an adjunct in multidisciplinary decision-making about adjuvant therapies in this patient population.
Sections du résumé
BACKGROUND
We hypothesized that the ratio of positive lymph nodes to total assessed lymph nodes (LNR) is an indicator of cancer burden in esophageal adenocarcinoma and may identify patients who may most benefit from AC.
OBJECTIVE
The aim of this study was to discern whether there is a threshold LNR above which AC is associated with a survival benefit in this population.
METHODS
The 2004-2015 National Cancer Database was queried for patients who underwent upfront, complete resection of pT1-4N1-3M0 esophageal adenocarcinoma. The primary outcome, overall survival, was examined using multivariable Cox proportional hazards models employing an interaction term between LNR and AC.
RESULTS
A total of 1733 patients were included: 811 (47%) did not receive AC whereas 922 (53%) did. The median LNR was 20% (interquartile range 9-40). In a multivariable Cox model, the interaction term between LNR and receipt of AC was significant (P = 0.01). A plot of the interaction demonstrated that AC was associated with improved survival beyond a LNR of about 10%-12%. In a sensitivity analysis, the receipt of AC was not associated with improved survival in patients with LNR <12% (hazard ratio 1.02; 95% confidence interval 0.72-1.44) but was associated with improved survival in those with LNR ≥12% (hazard ratio 0.65; 95% confidence interval 0.50-0.79).
CONCLUSIONS
In this study of patients with upfront, complete resection of node-positive esophageal adenocarcinoma, AC was associated with improved survival for LNR ≥12%. LNR may be used as an adjunct in multidisciplinary decision-making about adjuvant therapies in this patient population.
Identifiants
pubmed: 32649467
pii: 00000658-202203000-00036
doi: 10.1097/SLA.0000000000004150
pmc: PMC7790855
mid: NIHMS1619938
doi:
Types de publication
Journal Article
Research Support, N.I.H., Extramural
Langues
eng
Sous-ensembles de citation
IM
Pagination
e562-e567Subventions
Organisme : NCI NIH HHS
ID : P30 CA008748
Pays : United States
Organisme : NCI NIH HHS
ID : P30 CA014236
Pays : United States
Organisme : NCI NIH HHS
ID : T32 CA093245
Pays : United States
Organisme : NHLBI NIH HHS
ID : T32 HL069749
Pays : United States
Commentaires et corrections
Type : CommentIn
Informations de copyright
Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.
Déclaration de conflit d'intérêts
The authors have no conflicts of interest to disclose.
Références
National Comprehensive Cancer Network. Esophageal and Esophagogastric Junction Cancers (Version 1.2020). Available at: https://www.nccn.org/professionals/physician_gls/pdf/esophageal.pdf . Accessed April 27, 2020.
Speicher PJ, Englum BR, Ganapathi AM, et al. Adjuvant chemotherapy is associated with improved survival after esophagectomy without induction therapy for node-positive adenocarcinoma. J Thorac Oncol 2015; 10:181–188.
Revels SL, Morris AM, Reddy RM, et al. Racial disparities in esophageal cancer outcomes. Ann Surg Oncol 2013; 20:1136–1141.
Ikoma N, Cormier JN, Feig B, et al. Racial disparities in preoperative chemotherapy use in gastric cancer patients in the United States: analysis of the National Cancer Data Base, 2006-2014. Cancer 2018; 124:998–1007.
Steyerberg EW, Neville B, Weeks JC, et al. Referral patterns, treatment choices, and outcomes in locoregional esophageal cancer: a population-based analysis of elderly patients. J Clin Oncol 2007; 25:2389–2396.
Liu JH, Zingmond DS, McGory ML, et al. Disparities in the utilization of high-volume hospitals for complex surgery. JAMA 2006; 296:1973–1980.
Liu YP, Ma L, Wang SJ, et al. Prognostic value of lymph node metastases and lymph node ratio in esophageal squamous cell carcinoma. Eur J Surg Oncol 2010; 36:155–159.
Wilson M, Rosato EL, Chojnacki KA, et al. Prognostic significance of lymph node metastases and ratio in esophageal cancer. J Surg Res 2008; 146:11–15.
Tachibana M, Dhar DK, Kinugasa S, et al. Esophageal cancer with distant lymph node metastasis: prognostic significance of metastatic lymph node ratio. J Clin Gastroenterol 2000; 31:318–322.
Greenstein AJ, Litle VR, Swanson SJ, et al. Prognostic significance of the number of lymph node metastases in esophageal cancer. J Am Coll Surg 2008; 206:239–246.
Tan Z, Ma G, Yang H, et al. Can lymph node ratio replace pn categories in the tumor-node-metastasis classification system for esophageal cancer? J Thorac Oncol 2014; 9:1214–1221.
Bhamidipati CM, Stukenborg GJ, Thomas CJ, et al. Pathologic lymph node ratio is a predictor of survival in esophageal cancer. Ann Thorac Surg 2012; 94:1643–1651.
He Z, Wu S, Li Q, et al. Use of the metastatic lymph node ratio to evaluate the prognosis of esophageal cancer patients with node metastasis following radical esophagectomy. PLoS One 2013; 8:e73446.
Hsu W-H, Hsu P-K, Hsieh C-C, et al. The metastatic lymph node number and ratio are independent prognostic factors in esophageal cancer. J Gastrointest Surg 2009; 13:1913–1920.
Wei C, Deng W-Y, Li N, et al. Lymph node ratio as an alternative to the number of metastatic lymph nodes for the prediction of esophageal carcinoma patient survival. Dig Dis Sci 2015; 60:2771–2776.
Wang N, Jia Y, Wang J, et al. Prognostic significance of lymph node ratio in esophageal cancer. Tumour Biol 2015; 36:2335–2341.
Hou X, Wei J-C, Xu Y, et al. The positive lymph node ratio predicts long-term survival in patients with operable thoracic esophageal squamous cell carcinoma in China. Ann Surg Oncol 2013; 20:1653–1659.
Zhao Y, Zhong S, Li Z, et al. Pathologic lymph node ratio is a predictor of esophageal carcinoma patient survival: a literature-based pooled analysis. Oncotarget 2017; 8:62231–62239.
Lagergren J, Mattsson F, Zylstra J, et al. Extent of lymphadenectomy and prognosis after esophageal cancer surgery. JAMA Surg 2016; 151:32–39.
Jabo B, Selleck MJ, Morgan JW, et al. Role of lymph node ratio in selection of adjuvant treatment (chemotherapy vs. chemoradiation) in patients with resected gastric cancer. J Gastrointest Oncol 2018; 9:708–717.
Aoyama T, Yamamoto N, Kamiya M, et al. The lymph node ratio is an independent prognostic factor in pancreatic cancer patients who receive curative resection followed by adjuvant chemotherapy. Anticancer Res 2018; 38:4877–4882.
Ooki A, Akagi K, Yatsuoka T, et al. Lymph node ratio as a risk factor for recurrence after adjuvant chemotherapy in stage III colorectal cancer. J Gastrointest Surg 2017; 21:867–878.
Burt BM, Groth SS, Sada YH, et al. Utility of adjuvant chemotherapy after neoadjuvant chemoradiation and esophagectomy for esophageal cancer. Ann Surg 2017; 266:297–304.
Atay SM, Blum M, Sepesi B. Adjuvant chemotherapy following trimodality therapy for esophageal carcinoma—is the evidence sufficient? J Thorac Dis 2017; 9:3626–3629.
Bilimoria KY, Stewart AK, Winchester DP, et al. The National Cancer Data Base: a powerful initiative to improve cancer care in the United States. Ann Surg Oncol 2008; 15:683–690.
Harrell FE. Harrell Frank E Jr. Multivariable modeling strategies. Regression Modeling Strategies: With Applications to Linear Models, Logistic and Ordinal Regression, and Survival Analysis. Springer Series in Statistics . Cham: Springer International Publishing; 2015. 63–102.
MatchIt: Nonparametric Preprocessing for Parametric Causal Inference. Available at: https://gking.harvard.edu/matchit . Accessed April 18, 2019.
Li Y, Zhao W, Ni J, et al. Predicting the value of adjuvant therapy in esophageal squamous cell carcinoma by combining the total number of examined lymph nodes with the positive lymph node ratio. Ann Surg Oncol 2019; 26:2367–2374.
Ando N, Iizuka T, Kakegawa T, et al. A randomized trial of surgery with and without chemotherapy for localized squamous carcinoma of the thoracic esophagus: the Japan Clinical Oncology Group Study. J Thorac Cardiovasc Surg 1997; 114:205–209.