TY - JOUR
T1 - Esophageal cancer: Associations with (pN+) lymph node metastases
AU - Rice, Thomas W.
AU - Ishwaran, Hemant
AU - Hofstetter, Wayne L.
AU - Schipper, Paul H.
AU - Kesler, Kenneth A.
AU - Law, Simon
AU - Lerut, Toni
AU - Denlinger, Chadrick E.
AU - Salo, Jarmo A.
AU - Scott, Walter J.
AU - Watson, Thomas J.
AU - Allen, Mark S.
AU - Chen, Long Qi
AU - Rusch, Valerie W.
AU - Cerfolio, Robert J.
AU - Luketich, James D.
AU - Duranceau, Andre
AU - Darling, Gail E.
AU - Pera, Manuel
AU - Apperson-Hansen, Carolyn
AU - Blackstone, Eugene H.
PY - 2017/1/1
Y1 - 2017/1/1
N2 - Copyright © 2016 Wolters Kluwer Health, Inc. Objectives: To identify the associations of lymph node metastases (pN+), number of positive nodes, and pN subclassification with cancer, treatment, patient, geographic, and institutional variables, and to recommend extent of lymphadenectomy needed to accurately detect pN+ for esophageal cancer. Summary Background Data: Limited data and traditional analytic techniques have precluded identifying intricate associations of pN+ with other cancer, treatment, and patient characteristics. Methods: Data on 5806 esophagectomy patients from theWorldwide Esophageal Cancer Collaboration were analyzed by Random Forest machine learning techniques. Results: pN+, number of positive nodes, and pN subclassification were associated with increasing depth of cancer invasion (pT), increasing cancer length, decreasing cancer differentiation (G), and more regional lymph nodes resected. Lymphadenectomy necessary to accurately detect pN+ is 60 for shorter, well-differentiated cancers (<2.5 cm) and 20 for longer, poorly differentiated ones. Conclusions: In esophageal cancer, pN+, increasing number of positive nodes, and increasing pN classification are associated with deeper invading, longer, and poorly differentiated cancers. Consequently, if the goal of lymphadenectomy is to accurately define pN+ status of such cancers, few nodes need to be removed. Conversely, superficial, shorter, and well-differentiated cancers require a more extensive lymphadenectomy to accurately define pN+ status.
AB - Copyright © 2016 Wolters Kluwer Health, Inc. Objectives: To identify the associations of lymph node metastases (pN+), number of positive nodes, and pN subclassification with cancer, treatment, patient, geographic, and institutional variables, and to recommend extent of lymphadenectomy needed to accurately detect pN+ for esophageal cancer. Summary Background Data: Limited data and traditional analytic techniques have precluded identifying intricate associations of pN+ with other cancer, treatment, and patient characteristics. Methods: Data on 5806 esophagectomy patients from theWorldwide Esophageal Cancer Collaboration were analyzed by Random Forest machine learning techniques. Results: pN+, number of positive nodes, and pN subclassification were associated with increasing depth of cancer invasion (pT), increasing cancer length, decreasing cancer differentiation (G), and more regional lymph nodes resected. Lymphadenectomy necessary to accurately detect pN+ is 60 for shorter, well-differentiated cancers (<2.5 cm) and 20 for longer, poorly differentiated ones. Conclusions: In esophageal cancer, pN+, increasing number of positive nodes, and increasing pN classification are associated with deeper invading, longer, and poorly differentiated cancers. Consequently, if the goal of lymphadenectomy is to accurately define pN+ status of such cancers, few nodes need to be removed. Conversely, superficial, shorter, and well-differentiated cancers require a more extensive lymphadenectomy to accurately define pN+ status.
KW - Esophageal cancer
KW - PN+
KW - Worldwide esophageal cancer collaboration (WECC)
U2 - 10.1097/SLA.0000000000001594
DO - 10.1097/SLA.0000000000001594
M3 - Article
SN - 0003-4932
VL - 265
SP - 122
EP - 129
JO - Annals of Surgery
JF - Annals of Surgery
IS - 1
ER -