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Published in: BMC Cancer 1/2023

Open Access 01-12-2023 | Metastasis | Research

Pararespiratory and paradigestive lymph node metastases in esophageal squamous cell carcinoma: predicting survival and refining the N staging system

Authors: Dong Tian, Kai-Yuan Jiang, Yu-Shang Yang, Hao-Ji Yan, Rui-Xuan Yu, Heng Huang, Shun-Hai Jian, Hai-Ning Zhou, Hong-Ying Wen, Long-Qi Chen

Published in: BMC Cancer | Issue 1/2023

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Abstract

Background

The site of lymph node metastasis (LNM) may affect the prognosis of patients with esophageal squamous cell carcinoma (ESCC). To investigate the prognoses of pararespiratory and paradigestive LNM and to propose a novel N (nN) staging system that integrates both the LNM site and count.

Methods

This study was a multicenter, large-sample, retrospective cohort study that included ESCC patients with LNM between January 2014 and December 2019 from three Chinese institutes. Patients were set into training (two institutes) and external validation (one institute) cohorts. The primary outcomes were survival differences in LNM site and the development of novel nodal staging system. The overall survival (OS) of patients with pararespiratory LNM only (Group A), paradigestive LNM only (Group B), and both sites (Group C) was evaluated by Kaplan-Meier. Cox proportional hazards models were used to identify the independent prognostic factors. An nN staging system considering both the LNM site and count was developed and evaluated by the area under the receiver operating characteristic curve (AUC).

Results

In total, 1313 patients were included and split into training (n = 1033) and external validation (n = 280) cohorts. There were 342 (26.0%), 568 (43.3%) and 403 (30.7%) patients in groups A, B and C, respectively. The OS of patients with pararespiratory and patients with paradigestive LNM presented significant differences in the training and validation cohorts (P < 0.050). In the training cohort, LNM site was an independent prognostic factor (hazard ratio: 1.58, 95% confidence intervals: 1.41–1.77, P < 0.001). The nN staging definition: nN1 (1–2 positive pararespiratory/paradigestive LNs), nN2 (3–6 pararespiratory LNs or 1 pararespiratory with 1paradigestive LN), nN3 (3–6 LNs with ≥ 1 paradigestive LN), nN4 (≥ 7 LNs). Subsets of patients with different nN stages showed significant differences in OS (P < 0.050). The prognostic model of the nN staging system presented higher performance in the training and validation cohorts at 3-year OS (AUC, 0.725 and 0.751, respectively) and 5-year OS (AUC, 0.740 and 0.793, respectively) than the current N staging systems.

Conclusions

Compared to pararespiratory LNM, the presence of paradigestive LNM is associated with worse OS. The nN staging system revealed superior prognostic ability than current N staging systems.
Appendix
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Metadata
Title
Pararespiratory and paradigestive lymph node metastases in esophageal squamous cell carcinoma: predicting survival and refining the N staging system
Authors
Dong Tian
Kai-Yuan Jiang
Yu-Shang Yang
Hao-Ji Yan
Rui-Xuan Yu
Heng Huang
Shun-Hai Jian
Hai-Ning Zhou
Hong-Ying Wen
Long-Qi Chen
Publication date
01-12-2023
Publisher
BioMed Central
Keyword
Metastasis
Published in
BMC Cancer / Issue 1/2023
Electronic ISSN: 1471-2407
DOI
https://doi.org/10.1186/s12885-023-11055-2

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