The Association BetweenOverall Survival and theTotal Number of DissectedLymph Nodes: An ArtifactCaused by the SurgicalPathologist?

摘要

To the Editor:In an interesting study, Altorki et al1 retrospectively examined the association between overall survival and the number of dissected lymph nodes in patients with esophageal cancer and described a reduced risk of death with increasing lymph node yield. Previous studies could also demonstrate that the number of dissected lymph nodes might be a favorable prognostic factor in patients with esophageal or colon can-cer.This improvement in survival is usually attributed to a stage migration effect. With a higher lymph node yield, the probability of identifying lymph node metastases increases in cases that otherwise would have been falsely diagnosed as node negative. Yet in the study by Altorki et al1 the survival benefit of extended nodal dissection in patients with lymph node metastases was independent of the absolute number of positive nodes. Therefore the authors postulated that it might not be due to higher tumor burdens in patients with lower total nodal counts.