Sökning: onr:"swepub:oai:openarchive.ki.se:10616/44857" >
Extent of lymphaden...
Extent of lymphadenectomy and prognosis after esophageal cancer surgery
-
- Lagergren, Jesper (författare)
- Karolinska Institutet
-
Mattsson, Fredrik (författare)
-
Zylstra, Janine (författare)
-
visa fler...
-
Chang, Fuju (författare)
-
Gossage, James (författare)
-
Mason, Robert (författare)
-
- Lagergren, Pernilla (författare)
- Karolinska Institutet
-
Davies, Andrew (författare)
-
visa färre...
-
-
-
visa fler...
-
(creator_code:org_t)
-
visa färre...
- ISSN 2168-6254
- Stockholm : Karolinska Institutet, Dept of Molecular Medicine and Surgery, 2015
- 2015
- Engelska.
-
Ingår i: JAMA Surgery. - Stockholm : Karolinska Institutet, Dept of Molecular Medicine and Surgery. - 2168-6254 .- 2168-6262.
- Relaterad länk:
-
http://hdl.handle.ne... (primary) (Object in context) (free)
-
visa fler...
-
http://openarchive.k...
-
http://hdl.handle.ne... (primary) (Object in context) (free)
-
http://hdl.handle.ne...
-
https://doi.org/10.1...
-
http://hdl.handle.ne...
-
http://kipublication...
-
visa färre...
Abstract
Ämnesord
Stäng
- Importance: The prognostic role of the extent of lymphadenectomy during surgery for esophageal cancer is uncertain and requires clarification. Objective: To clarify whether the number of removed lymph nodes influences mortality following surgery for esophageal cancer. Design, Setting, and Participants: Conducted from January 1, 2000, to January 31, 2014, this was a cohort study of patients who underwent esophagectomy for cancer in 2000-2012 at a high-volume hospital for esophageal cancer surgery, with follow-up until 2014. Exposures: The main exposure was the number of resected lymph nodes. Secondary exposures were the number of metastatic lymph nodes and positive to negative lymph node ratio. Main Outcomes and Measures: The independent role of the extent of lymphadenectomy in relation to all-cause and disease-specific 5-year mortality was analyzed using Cox proportional hazard regression models, providing hazard ratios (HRs) with 95% CIs. The HRs were adjusted for age, pathological T category, tumor differentiation, margin status, calendar period of surgery, and response to preoperative chemotherapy. Results: Among 606 included patients, 506 (83.5%) had adenocarcinoma of the esophagus, 323 (53%) died within 5 years of surgery, and 235 (39%) died of tumor recurrence. The extent of lymphadenectomy was not statistically significantly associated with all-cause or disease-specific mortality, independent of the categorization of lymphadenectomy or stratification for T category, calendar period, or chemotherapy. Patients in the fourth quartile of the number of removed nodes (21-52 nodes) did not demonstrate a statistically significant reduction in all-cause 5-year mortality compared with those in the lowest quartile (0-10 nodes) (HR, 0.86; 95% CI, 0.63-1.17), particularly not in the most recent calendar period (HR, 0.98; 95% CI, 0.57-1.66 for years 2007-2012). A greater number of metastatic nodes and a higher positive to negative node ratio was associated with increased mortality rates, and these associations showed dose-response associations. Conclusions and Relevance: This study indicated that the extent of lymphadenectomy during surgery for esophageal cancer might not influence 5-year all-cause or disease-specific survival. These results challenge current clinical guidelines. This cohort study indicates that the extent of lymphadenectomy during surgery for esophageal cancer might not influence the 5-year all-cause or disease-specific survival. These results challenge current clinical guidelines.
Publikations- och innehållstyp
- ref (ämneskategori)
- art (ämneskategori)
Hitta via bibliotek
Till lärosätets databas