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A Propensity Score-Matched Cohort Study to Evaluate the Association of Lymph Node Retrieval with Long-Term Overall Survival in Patients with Esophageal Cancer

BACKGROUND: Previous studies evaluating the association of lymph node (LN) yield and survival presented conflicting results and many may be influenced by confounding and stage migration. OBJECTIVE: This study aimed to evaluate whether the quality indicator ‘retrieval of at least 15 LNs’ is associate...

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Autores principales: van der Werf, Leonie R., Marra, Elske, Gisbertz, Suzanne S., Wijnhoven, Bas P. L., van Berge Henegouwen, Mark I.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Springer International Publishing 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7752882/
https://www.ncbi.nlm.nih.gov/pubmed/33067746
http://dx.doi.org/10.1245/s10434-020-09142-w
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author van der Werf, Leonie R.
Marra, Elske
Gisbertz, Suzanne S.
Wijnhoven, Bas P. L.
van Berge Henegouwen, Mark I.
author_facet van der Werf, Leonie R.
Marra, Elske
Gisbertz, Suzanne S.
Wijnhoven, Bas P. L.
van Berge Henegouwen, Mark I.
author_sort van der Werf, Leonie R.
collection PubMed
description BACKGROUND: Previous studies evaluating the association of lymph node (LN) yield and survival presented conflicting results and many may be influenced by confounding and stage migration. OBJECTIVE: This study aimed to evaluate whether the quality indicator ‘retrieval of at least 15 LNs’ is associated with better long-term survival and more accurate pathological staging in patients with esophageal cancer treated with neoadjuvant chemoradiotherapy and resection. METHODS: Data of esophageal cancer patients who underwent neoadjuvant chemoradiotherapy and surgery between 2011 and 2016 were retrieved from the Dutch Upper Gastrointestinal Cancer Audit. Patients with < 15 and ≥ 15 LNs were compared after propensity score matching based on patient and tumor characteristics. The primary endpoint was 3-year survival. To evaluate the effect of LN yield on the accuracy of pathological staging, pathological N stage was evaluated and 3-year survival was analyzed in a subgroup of patients with node-negative disease. RESULTS: In 2260 of 3281 patients (67%) ≥ 15 LNs were retrieved. In total, 992 patients with ≥ 15 LNs were matched to 992 patients with < 15 LNs. The 3-year survival did not differ between the two groups (57% vs. 54%; p = 0.28). pN+ was scored in 41% of patients with ≥ 15 LNs versus 35% of patients with < 15 LNs. For node-negative patients, the 3-year survival was significantly better for patients with ≥ 15 LNs (69% vs. 61%, p = 0.01). CONCLUSIONS: n this propensity score-matched cohort, 3-year survival was comparable for patients with ≥ 15 LNs, although increasing nodal yield was associated with more accurate staging. In node-negative patients, 3-year survival was higher for patients with ≥ 15 LNs. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1245/s10434-020-09142-w) contains supplementary material, which is available to authorized users.
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spelling pubmed-77528822020-12-28 A Propensity Score-Matched Cohort Study to Evaluate the Association of Lymph Node Retrieval with Long-Term Overall Survival in Patients with Esophageal Cancer van der Werf, Leonie R. Marra, Elske Gisbertz, Suzanne S. Wijnhoven, Bas P. L. van Berge Henegouwen, Mark I. Ann Surg Oncol Thoracic Oncology BACKGROUND: Previous studies evaluating the association of lymph node (LN) yield and survival presented conflicting results and many may be influenced by confounding and stage migration. OBJECTIVE: This study aimed to evaluate whether the quality indicator ‘retrieval of at least 15 LNs’ is associated with better long-term survival and more accurate pathological staging in patients with esophageal cancer treated with neoadjuvant chemoradiotherapy and resection. METHODS: Data of esophageal cancer patients who underwent neoadjuvant chemoradiotherapy and surgery between 2011 and 2016 were retrieved from the Dutch Upper Gastrointestinal Cancer Audit. Patients with < 15 and ≥ 15 LNs were compared after propensity score matching based on patient and tumor characteristics. The primary endpoint was 3-year survival. To evaluate the effect of LN yield on the accuracy of pathological staging, pathological N stage was evaluated and 3-year survival was analyzed in a subgroup of patients with node-negative disease. RESULTS: In 2260 of 3281 patients (67%) ≥ 15 LNs were retrieved. In total, 992 patients with ≥ 15 LNs were matched to 992 patients with < 15 LNs. The 3-year survival did not differ between the two groups (57% vs. 54%; p = 0.28). pN+ was scored in 41% of patients with ≥ 15 LNs versus 35% of patients with < 15 LNs. For node-negative patients, the 3-year survival was significantly better for patients with ≥ 15 LNs (69% vs. 61%, p = 0.01). CONCLUSIONS: n this propensity score-matched cohort, 3-year survival was comparable for patients with ≥ 15 LNs, although increasing nodal yield was associated with more accurate staging. In node-negative patients, 3-year survival was higher for patients with ≥ 15 LNs. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1245/s10434-020-09142-w) contains supplementary material, which is available to authorized users. Springer International Publishing 2020-10-16 2021 /pmc/articles/PMC7752882/ /pubmed/33067746 http://dx.doi.org/10.1245/s10434-020-09142-w Text en © The Author(s) 2020 Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.
spellingShingle Thoracic Oncology
van der Werf, Leonie R.
Marra, Elske
Gisbertz, Suzanne S.
Wijnhoven, Bas P. L.
van Berge Henegouwen, Mark I.
A Propensity Score-Matched Cohort Study to Evaluate the Association of Lymph Node Retrieval with Long-Term Overall Survival in Patients with Esophageal Cancer
title A Propensity Score-Matched Cohort Study to Evaluate the Association of Lymph Node Retrieval with Long-Term Overall Survival in Patients with Esophageal Cancer
title_full A Propensity Score-Matched Cohort Study to Evaluate the Association of Lymph Node Retrieval with Long-Term Overall Survival in Patients with Esophageal Cancer
title_fullStr A Propensity Score-Matched Cohort Study to Evaluate the Association of Lymph Node Retrieval with Long-Term Overall Survival in Patients with Esophageal Cancer
title_full_unstemmed A Propensity Score-Matched Cohort Study to Evaluate the Association of Lymph Node Retrieval with Long-Term Overall Survival in Patients with Esophageal Cancer
title_short A Propensity Score-Matched Cohort Study to Evaluate the Association of Lymph Node Retrieval with Long-Term Overall Survival in Patients with Esophageal Cancer
title_sort propensity score-matched cohort study to evaluate the association of lymph node retrieval with long-term overall survival in patients with esophageal cancer
topic Thoracic Oncology
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7752882/
https://www.ncbi.nlm.nih.gov/pubmed/33067746
http://dx.doi.org/10.1245/s10434-020-09142-w
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