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Identification of Optimal Parameters for Assessing Lymph Node Status of Patients with Esophageal Squamous Cell Carcinoma After Neoadjuvant Chemoradiotherapy

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

Abstract

Background

This study aimed to compare the prognostic discrimination power of pretreatment pathologic N stage (prepN), lymph node tumor regression grade (LNTRG), and posttreatment pathologic N (ypN) category for esophageal squamous cell carcinoma (ESCC) patients who received neoadjuvant chemoradiotherapy (nCRT) plus surgery.

Methods

The study reviewed 187 ESCC patients from two medical centers who underwent nCRT plus surgery. Pathologic LNTRG was defined by the proportion of viable tumor area within the tumor bed in lymph nodes (LNs). An average LNTRG then was calculated by averaging the tumor regression grade (TRG) score of all resected LNs. Lymph nodes containing regression changes or vital tumor cells were used for interpretation of the prepN stage, which reflects the estimated number of originally involved LNs.

Results

The ypN, prepN, and LNTRG categories had significant prognostic stratification power (p < 0.001, log-rank test). Multivariable cox regression showed that all three categories were independent prognostic factors of disease-free survival (DFS) (p < 0.05). The LNTRG category showed a better prognostic value for DFS prediction than the ypN and prepN categories (Akaike information criterion [AIC]: LNTRG [933.69], ypN [937.56], prepN [937.45]). Additionally, the superior predictive capacity of the LNTRG category was demonstrated by decision curve analysis. Similar results were discovered for patients with remaining diseased LNs.

Conclusions

The three staging categories had prognostic relevance for DFS, with the LNTRG category seeming to have better prognostic indication power. Comprehensive consideration of the ypN status, prepN status, and LN regression may allow for better prognostic stratification of patients.

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Acknowledgments

This work was supported by the National Natural Science Foundation of China (Grant No. 81902396) and Zhongshan Hospital (Grant Nos. 2020ZSLC5 and 2021ZSYQ27).

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Author notes

  1. Xu Huang and Dongxian Jiang have contributed equally to this work.

Authors and Affiliations

  1. Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai, China

    Xu Huang MD, Han Tang MD & Lijie Tan MD

  2. Department of Pathology, Zhongshan Hospital, Fudan University, Shanghai, China

    Dongxian Jiang MD & Yingyong Hou MD

  3. The School of Basic Medical Sciences, Fudan University, Shanghai, China

    Zitao Jian MD & Tiantao Sun MD

  4. Department of Radiotherapy, Zhongshan Hospital, Fudan University, Shanghai, China

    Zhaochong Zeng MD

  5. Department of Radiotherapy, Zhongshan Hospital, Xiamen University, Shanghai, China

    Shumin Zhang MD

  6. Department of Thoracic, Zhongshan Hospital, Xiamen University, Shanghai, China

    Hong Fan MD & Lijie Tan MD

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  1. Xu Huang MD
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  2. Dongxian Jiang MD
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  3. Zitao Jian MD
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  4. Zhaochong Zeng MD
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  8. Han Tang MD
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Corresponding authors

Correspondence to Han Tang MD, Yingyong Hou MD or Lijie Tan MD.

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Huang, X., Jiang, D., Jian, Z. et al. Identification of Optimal Parameters for Assessing Lymph Node Status of Patients with Esophageal Squamous Cell Carcinoma After Neoadjuvant Chemoradiotherapy. Ann Surg Oncol 31, 883–891 (2024). https://doi.org/10.1245/s10434-023-14135-6

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  • DOI: https://doi.org/10.1245/s10434-023-14135-6

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