Ma Keru, Wang Hao, Fang Chengyuan, Jiang Xiangyu, Ma Jianqun
Department of Thoracic Surgery, Esophagus and Mediastinum, Harbin Medical University Cancer Hospital, Harbin, China.
Department of Gastroenterological Surgery, Harbin Medical University Cancer Hospital, Harbin, China.
Front Oncol. 2023 May 2;13:1113711. doi: 10.3389/fonc.2023.1113711. eCollection 2023.
Patients with stage pN3 esophageal cancer (EC) have a large number of metastatic lymph nodes (mLNs) and have poor prognosis. This study was to elucidate whether subclassification of pN3 according to the number of mLNs could improve the discrimination ability of EC patients.
This study retrospectively analyzed patients with pN3 EC from the Surveillance, Epidemiology, and End Results (SEER) database as a training cohort and SEER validation cohort. Patients with pN3 esophageal cancer from the Affiliated Cancer Hospital of Harbin Medical University were used as the validation cohort. The optimal cutoff value of mLNs was identified using the X-tile software, and group pN3 into pN3-I and pN3-II based on mLNs. Kaplan-Meier method and log-rank test were used to analyze the disease-specific survival (DSS). The Cox proportional hazards regression analysis was used to identify the independent prognostic factors.
For the training cohort, patients with 7 to 9 mLNs were categorized as pN3-I, while those with more than 9 mLNs were categorized as pN3-II. There were 183 (53.8%) pN3-I and 157 (46.2%) pN3-II. The 5-year DSS rates of pN3-I and pN3-II in the training cohort were 11.7% and 5.2% (=0.033), and the pN3 subclassification was an independent risk factor associated with patient prognosis. More RLNs may not improve patient prognosis, but the use of mLNs/RLNs is effective in predicting patient prognosis. Furthermore, the pN3 subclassification was well validated in the validation cohort.
Subclassification of pN3 can better distinguish survival differences in EC patients.
pN3期食管癌（EC）患者有大量转移淋巴结（mLNs），预后较差。本研究旨在阐明根据mLNs数量对pN3进行亚分类是否能提高对EC患者的鉴别能力。
本研究回顾性分析了监测、流行病学和最终结果（SEER）数据库中的pN3期EC患者作为训练队列和SEER验证队列。哈尔滨医科大学附属肿瘤医院的pN3期食管癌患者用作验证队列。使用X-tile软件确定mLNs的最佳截断值，并根据mLNs将pN3组分为pN3-I和pN3-II。采用Kaplan-Meier法和对数秩检验分析疾病特异性生存（DSS）。采用Cox比例风险回归分析确定独立预后因素。
对于训练队列，mLNs为7至9个的患者分类为pN3-I，而mLNs超过9个的患者分类为pN3-II。有183例（53.8%）pN3-I和157例（46.2%）pN3-II。训练队列中pN3-I和pN3-II的5年DSS率分别为11.7%和5.2%（=0.033），pN3亚分类是与患者预后相关的独立危险因素。更多的区域淋巴结（RLNs）可能不会改善患者预后，但使用mLNs/RLNs可有效预测患者预后。此外，pN3亚分类在验证队列中得到了很好的验证。
pN3亚分类能更好地区分EC患者的生存差异。
