ArticleJournal of thoracic disease2025
The impact of extended lymphadenectomy on survival in esophageal adenocarcinoma with complete pathologic response: a retrospective study.
Article in Journal of thoracic disease, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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Abstract
Background: The impact of extended lymphadenectomy in esophageal adenocarcinoma (EAC) has been established in recent literature. The role of lymph node harvest in those achieving a complete pathologic response (CPR) is less clear. We aim to further investigate the impact of extended lymphadenectomy on survival in those patients with CPR. Methods: The National Cancer Database (NCDB) was queried from 2006-2021 for patients with EAC without distant metastasis who received trimodal therapy. Groups of <10, 10-20, and >20 nodes harvested were established. Multivariable Cox regression and Kaplan-Meier survival analyses were conducted. Results: Of 17,292 patients identified, 20.51% (n=3,547) had CPR. Multivariable analysis identified extended lymphadenectomy as an independent prognostic factor for survival in those with CPR [10-20 nodes, hazard ratio (HR) 0.847, P=0.03; >20 nodes, HR 0.768, P=0.01]. Median survival was longer in the 10-20 nodes (91.70 months) and >20 nodes (81.15 months) groups compared to the <10 nodes group (59.70 months, P=0.03), but similar between the 10-20 and >20 nodes groups (P=0.84). Analysis by clinical stage (cSTAGE) revealed no survival benefit with increasing nodal harvest in cSTAGE I (P=0.25) or cSTAGE II (P=0.12) disease. In those with cSTAGE III disease, increased nodal harvest served as an independent prognostic factor for survival (10-20 nodes HR 0.811, P=0.03; >20 nodes, HR 0.770, P=0.02). Median survival improved with 10-20 nodes (84.21 months) compared to <10 nodes (53.32 months, P=0.03) but not further with >20 nodes (74.64 months, P=0.74). Conclusions: These results suggest that the benefit of lymphadenectomy in those with CPR may be stage dependent. In our cohort, only those with cSTAGE III disease saw a benefit from a greater than >10 nodes harvest and no groups derived additional benefit from more extended lymphadenectomy (>20 nodes).
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