Wang Hang, Lin Zheng, Lin Yimin, Huang Ruigang, Qiu Moliang, Peng Xiane, He Fei, Huang Liping, Xiang Zhisheng, Lu Wanting, Yan Siyou, Liu Shuang, Yang Huimin, Zhang Zhihui, Hu Zhijian
Department of Epidemiology and Health Statistics, Fujian Provincial Key Laboratory of Environment factors and Cancer, School of Public Health, Fujian Medical University, Fuzhou, 350108, China.
Department of Disease Prevention and Healthcare, Fujian Provincial Hospital South Branch & Fujian Provincial Jinshan Hospital, Fuzhou, 350001, China.
J Cancer. 2021 Sep 3;12(21):6454-6464. doi: 10.7150/jca.61994. eCollection 2021.
The current Chinese draft nodal clinical staging system for unresectable esophageal cancer is controversial. Our study aimed to propose a new diagnostic criterion for lymph node metastasis (LNM) detected by multislice spiral computed tomography (MSCT) in nonsurgically treated esophageal squamous cell carcinoma (ESCC) patients and then develop a novel lymph node (LN) clinical staging system for better individual prognostic prediction. The short-axis diameters of regional LNs were measured in 393 nonsurgical patients. Regional nodes were considered positive for malignancy if the nodal size exceeded the optimal size, which was determined by Kaplan-Meier survival analysis. The novel LN clinical staging system was then constructed using the LASSO model based on the relative prognostic importance of different LN stations. Validation cohort was included to confirm the prognostic performance. Regional nodes were considered positive for malignancy if they were larger than 10 mm in the low cervical and upper thoracic segments, 7 mm in the middle thoracic segment, and 8 mm in the lower thoracic and celiac segments. Using the LASSO model, stations 2R, 3A, 7 and 16 were qualified in the model. Further analysis showed that our LN clinical staging system had better homogeneity, discriminatory ability and clinical value than the draft nodal staging system. Our results show that the new diagnostic criterion may improve the diagnostic value of MSCT in metastatic LNs. The novel LN clinical staging system can stratify nonsurgically treated ESCC patients into different risk groups, providing valuable information for decision making and outcome prediction.
目前中国不可切除食管癌的节点临床分期系统草案存在争议。我们的研究旨在为非手术治疗的食管鳞状细胞癌（ESCC）患者多层螺旋计算机断层扫描（MSCT）检测到的淋巴结转移（LNM）提出一种新的诊断标准，然后开发一种新的淋巴结（LN）临床分期系统，以更好地进行个体预后预测。在393例非手术患者中测量了区域淋巴结的短轴直径。如果淋巴结大小超过通过Kaplan-Meier生存分析确定的最佳大小，则区域淋巴结被视为恶性阳性。然后根据不同淋巴结站的相对预后重要性，使用LASSO模型构建新的LN临床分期系统。纳入验证队列以确认预后性能。如果区域淋巴结在颈下段和胸上段大于10 mm，胸中段大于7 mm，胸下段和腹腔段大于8 mm，则被视为恶性阳性。使用LASSO模型，2R、3A、7和16站符合模型要求。进一步分析表明，我们的LN临床分期系统比节点分期系统草案具有更好的同质性、鉴别能力和临床价值。我们的结果表明，新的诊断标准可能提高MSCT对转移性淋巴结的诊断价值。新的LN临床分期系统可以将非手术治疗的ESCC患者分层为不同的风险组，为决策和结果预测提供有价值的信息。
