Impact of examined lymph node number on accurate nodal staging and long-term survival of resected Siewert type II-III adenocarcinoma of the esophagogastric junction: A large population-based study

Baicheng Ding; Jiahui Yong; Lixiang Zhang; Panquan Luo; Endong Song; Abigail N Rankine; Zhijian Wei; Xingyu Wang; Aman Xu

doi:10.3389/fonc.2022.979338

Impact of examined lymph node number on accurate nodal staging and long-term survival of resected Siewert type II-III adenocarcinoma of the esophagogastric junction: A large population-based study

Front Oncol. 2022 Oct 31:12:979338. doi: 10.3389/fonc.2022.979338. eCollection 2022.

Authors

Baicheng Ding¹, Jiahui Yong², Lixiang Zhang³, Panquan Luo³, Endong Song³, Abigail N Rankine⁴, Zhijian Wei³, Xingyu Wang¹, Aman Xu³

Affiliations

¹ Department of Emergency Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei, China.
² Department of Transfusion, The First Affiliated Hospital of University of Science and Technology of China (USTC), Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China.
³ Department of Gastrointestinal Surgery, Department of General Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei, China.
⁴ Department of Clinical Medicine, Anhui Medical University, Hefei, China.

Abstract

Background: We aimed to investigate the association between the number of examined lymph nodes (ELNs) and accurate nodal staging and long-term survival in Siewert type II-III Adenocarcinoma of the Esophagogastric Junction (AEG) by using large population-based databases and determined the optimal ELN number threshold.

Methods: Data on Stage I-III Siewert type II-III AEG patients from 2010 to 2014 respectively from the United States (US) SEER database and a Chinese large medical center institutional registry were analyzed for correlation between the ELN number and stage migration (node negative-to-positive) and overall survival (OS) by using multivariable-adjusted logistic and Cox regression models, respectively. The series of odds ratios (ORs), and hazard ratios (HRs) were fitted with a LOWESS smoother, and the structural breakpoints were determined by Chow test. The selected optimal cut point was then validated with the 2015 to 2016 SEER database.

Results: Both the US cohort(n=1387) and China cohort(n=981) showed significantly increases from node-negative to node-positive disease (OR_theUS1.032,95%CI 1.017-1.046;OR_China1.034,95%CI 1.002-1.065) and enhancements in overall survival (HR_theUS0.970,95%CI 0.961-0.979;HR_China0.960,95%CI 0.940-0.980) with the increasing ELN number after controlling for confounders. Associations for both stage migration and overall survival were still significant in most subgroups' stratification. Cut point analysis showed a threshold ELN number of 18, which was validated both in the cohorts where it originated and in an independent SEER data cohort(n=379).

Conclusions: More ELNs are associated with accurate nodal staging(negative-to-positive) as well as higher overall survival in resected Siewert types II-III AEG, We recommend 18 ELNs as the optimal cut point for the quality assessment of postoperative lymph node examination or prognostic stratification in clinical practice.

Keywords: Siewert type; accurate nodal staging; adenocarcinoma of the esophagogastric junction (AEG); examined lymph node number; long-term survival; optimal cut point.