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

  • Thoracic Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

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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Acknowledgment

The authors are grateful for Martina Fu, the editorial assistant from Yi Li’s lab at the University of Michigan, for proofreading the manuscript and for many helpful suggestions that improved the presentation of the article. This study was supported by a Sichuan Science and Technology Program (2018HH0150).

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Author notes

  1. Yong Yuan and Hyokyoung G. Hong are joint first authors of this article.

Authors and Affiliations

  1. Department of Thoracic Surgery, West China Hospital of Sichuan University, Chengdu, Sichuan, China

    Yong Yuan MD, PhD, Yu-Shang Yang MD, Qi-Xin Shang MD & Long-Qi Chen MD, PhD

  2. Department of Statistics and Probability, Michigan State University, East Lansing, MI, USA

    Hyokyoung G. Hong PhD

  3. Big Data Center, West China Hospital of Sichuan University, Chengdu, China

    Xiaoxi Zeng MD, PhD & Yi Li PhD

  4. Department of Oncology Surgery, Shantou Affiliated Hospital, Sun Yat-sen University, Guangzhou, China

    Li-Yan Xu MD, Zhi-Yong Wu MD, Xiao-Dong Yao MD, Xiu-E Xu MD & Jian-Yi Wu MD

  5. Department of Thoracic Oncology, Sun Yat-sen University Cancer Center, Guangzhou, China

    Hong Yang MD, PhD & Jian-Hua Fu MD

  6. Department of Thoracic Surgery, Cancer Hospital Chinese Academy of Medical Sciences, Beijing, China

    Yin Li MD, PhD

  7. Department of Biostatistics, University of Michigan, Ann Arbor, MI, USA

    Yi Li PhD

Authors
  1. Yong Yuan MD, PhD
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Corresponding authors

Correspondence to Zhi-Yong Wu MD, Jian-Hua Fu MD or Long-Qi Chen MD, PhD.

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Yuan, Y., Hong, H.G., Zeng, X. et al. Lymph Node Station-Based Nodal Staging System for Esophageal Squamous Cell Carcinoma: A Large-Scale Multicenter Study. Ann Surg Oncol 26, 4045–4052 (2019). https://doi.org/10.1245/s10434-019-07601-7

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  • DOI: https://doi.org/10.1245/s10434-019-07601-7

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