Wen-Hui Hou, Li Jie, Liao Yao, Yu-Wei Yang, He Fang, Yuan-Yuan Zhao, Xian-Yan Chen, You-Ling Gong, Xiao-Bo Du
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引用次数: 0
Abstract
Background: At present, the definition of lymph node skipping metastases (NSM) in esophageal squamous cell carcinoma (ESCC) is not uniform, and there were few clinical prognostic models with NSM as a factor. On the other hand, N-staging of ESCC has long been controversial. This study aimed to define NSM in ESCC and investigate its prognostic implications. Meanwhile, according to the cumulative number of cervical, thoracic and abdominal region lymph nodes, a new N-stage was defined and compared with the N-stage of American Joint Committee on Cancer/the Union for International Cancer Control (AJCC/UICC) and Japan Esophageal Society (JES).
Methods: ESCC patients who underwent radical esophagectomy with lymph node metastases (LNM) between January 2012 and December 2022 at Mianyang Central Hospital and West China Hospital of Sichuan University. Patients were grouped into training and external validation cohorts. NSM was defined as any LNM outside the primary tumor region. Meanwhile, this study created a new postoperative pathology N-staging [PN(n)] based on the regional division of LNM to compare with the 8th edition of the AJCC/UICC and the 11th edition of JES N-staging.
Results: There were 232 patients enrolled (training: 161; validation: 71). Cox-regression identified factors that could predict outcomes independently. Kaplan-Meier survival analysis was performed. Model performance was evaluated using the area under the receiver operating characteristic curve (AUC) and calibration plots. Independent risk factors for death included NSM [hazard ratio (HR) =1.5202], age (HR =1.036), T-stage (HR =2.874), and AJCC/UICC N stage (HR =1.9601). Prognostic models for 1-year (AUC: 0.923, 0.985), 3-year (AUC: 0.747, 0.746), and 5-year (AUC: 0.695, 0.713) survival showed high accuracy.
Conclusions: NSM is associated with worse overall survival (OS) in ESCC, and the constructed prognostic model effectively predicts OS for ESCC patients.
期刊介绍：
The Journal of Thoracic Disease (JTD, J Thorac Dis, pISSN: 2072-1439; eISSN: 2077-6624) was founded in Dec 2009, and indexed in PubMed in Dec 2011 and Science Citation Index SCI in Feb 2013. It is published quarterly (Dec 2009- Dec 2011), bimonthly (Jan 2012 - Dec 2013), monthly (Jan. 2014-) and openly distributed worldwide. JTD received its impact factor of 2.365 for the year 2016. JTD publishes manuscripts that describe new findings and provide current, practical information on the diagnosis and treatment of conditions related to thoracic disease. All the submission and reviewing are conducted electronically so that rapid review is assured.
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