OGC P39 Absolute lymph node yield <15 is associated with reduced overall survival in patients undergoing oesophagectomy for oesophageal cancer and is an important quality metric
Bibliographic record
Abstract
Abstract Background Surgical resection following neoadjuvant therapy with either chemotherapy or chemoradiotherapy remains the cornerstone of curative management of oesophageal cancer. In spite of this, there remains uncertainty regarding the optimal radicality of lymphadenectomy, and whether increasing lymph node yields confer a true survival benefit. This study aims to assess the impact of lymph node yield and lymph node ratio on survival following surgery for oesophageal cancer, in addition to identifying factors that may influence lymph node yield and radicality of resection. Methods Patients in a single centre undergoing oesophagectomy with curative intent from January 1, 2010 to December 31, 2020 were reviewed. Clinical and pathological variables were assessed, with univariable, multivariable, regression and survival analyses performed as appropriate. Regression with cut-point analysis was used to determine the optimal cut-off for lymph node ratio and for minimum number of nodes resected. Results Three hundred and ninety-seven patients underwent oesophagectomy in the study period, with 288 of these having a minimally invasive operation (MIE). Stage (stage 3 HR: 1.64 (1.02–2.62), p=0.04, stage 4 HR: 2.50 (1.43–5.01), p=0.001), positive margin status (HR: 2.62 (1.57–4.36), p<0.001), lymph node yield <15 (HR: 2.62 (1.57–4.36), p<0.001) and an elevated lymph node ratio (HR: 8.42 (2.85–24.90, p<0.001) predicted survival. Patients undergoing MIE had higher lymph node yields compared with open procedures (30.7 vs 25.3, p<0.001). Patients undergoing neoadjuvant chemoradiation had lower lymph node yields compared with those with no neoadjuvant therapy and those with neoadjuvant chemotherapy (26.4 vs 30.6 vs 36.8 respectively, p<0.001). Cut-point regression analysis determined lymph node ratio of <0.05 was associated with a survival benefit. Cut-point analysis also demonstrated that resecting more than 15 lymph nodes had an associated benefit, and 15 nodes is the minimum that should be resected, consistent with guidelines. Conclusions Lymphadenectomy is a cornerstone of resection of oesophageal cancer. Low lymph node yield and high lymph node ratio are associated with reduced overall survival. A lymph node ratio of <0.05 is associated with significant survival benefit. The minimum number of lymph nodes that should be resected in esophageal cancer is 15, consistent with current guidelines.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.003 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".