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Annals of Surgical Oncology
Published in: Annals of Surgical Oncology 12/2019

01-11-2019 | Esophageal Cancer | Thoracic Oncology

Lymph Node Station-Based Nodal Staging System for Esophageal Squamous Cell Carcinoma: A Large-Scale Multicenter Study

Authors: Yong Yuan, MD, PhD, Hyokyoung G. Hong, PhD, Xiaoxi Zeng, MD, PhD, Li-Yan Xu, MD, Yu-Shang Yang, MD, Qi-Xin Shang, MD, Hong Yang, MD, PhD, Yin Li, MD, PhD, Yi Li, PhD, Zhi-Yong Wu, MD, Jian-Hua Fu, MD, Xiao-Dong Yao, MD, Xiu-E Xu, MD, Jian-Yi Wu, MD, Long-Qi Chen, MD, PhD

Published in: Annals of Surgical Oncology | Issue 12/2019

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Abstract

Background

The American Joint Committee on Cancer (AJCC) nodal staging for esophageal squamous cell carcinoma (ESCC) has been defined by the number of metastatic lymph nodes (N system). However, the precise counting of individual positive lymph nodes is difficult and unreliable in some clinical settings, which calls for a more available and reliable system. This study examined the performance of a newly proposed nodal staging category, termed the S system, based on the number of metastatic lymph node stations.

Methods

Using the Kaplan–Meier method and Cox-regression analysis, this study retrospectively analyzed the overall survival (OS) of 2285 ESCC patients who underwent esophagectomy in three major China hospitals. Predictive models were constructed, and C-indices were computed to evaluate the discriminatory power of the S system, and to compare it with the N system.

Results

The categories defined by the S system were more homogeneous in terms of OS than those defined by the N system. Overall, the S system had a slightly better C-index (p = 0.659) than the N system ((p = 0.658). Subgroup analyses also showed that the C-index of the S system was slightly better than that of the N system for each subgroup of sex and age, but the two were comparable for each subgroup defined by the tumor location.

Conclusion

The S system demonstrated a competing prognostic performance compared with the current AJCC N system. Due to the relatively easy accessibility of the number of metastatic lymph node stations, the S system may offer an easier option for cancer staging without a loss of discriminative power.
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Metadata
Title
Lymph Node Station-Based Nodal Staging System for Esophageal Squamous Cell Carcinoma: A Large-Scale Multicenter Study
Authors
Yong Yuan, MD, PhD
Hyokyoung G. Hong, PhD
Xiaoxi Zeng, MD, PhD
Li-Yan Xu, MD
Yu-Shang Yang, MD
Qi-Xin Shang, MD
Hong Yang, MD, PhD
Yin Li, MD, PhD
Yi Li, PhD
Zhi-Yong Wu, MD
Jian-Hua Fu, MD
Xiao-Dong Yao, MD
Xiu-E Xu, MD
Jian-Yi Wu, MD
Long-Qi Chen, MD, PhD
Publication date
01-11-2019
Publisher
Springer International Publishing
Published in
Annals of Surgical Oncology / Issue 12/2019
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-019-07601-7

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