Department of Thoracic Surgery, West China Hospital, Sichuan University, 37 Guoxue Alley, Chengdu, 610041, China.
Department of Cardiothoracic Intensive Care Unit, Affiliated Hospital of North Sichuan Medical College, Nanchong, 637000, China.
BMC Cancer. 2023 Jul 24;23(1):695. doi: 10.1186/s12885-023-11055-2.
The site of lymph node metastasis (LNM) may affect the prognosis of patients with esophageal squamous cell carcinoma (ESCC). To investigate the prognoses of pararespiratory and paradigestive LNM and to propose a novel N (nN) staging system that integrates both the LNM site and count.
This study was a multicenter, large-sample, retrospective cohort study that included ESCC patients with LNM between January 2014 and December 2019 from three Chinese institutes. Patients were set into training (two institutes) and external validation (one institute) cohorts. The primary outcomes were survival differences in LNM site and the development of novel nodal staging system. The overall survival (OS) of patients with pararespiratory LNM only (Group A), paradigestive LNM only (Group B), and both sites (Group C) was evaluated by Kaplan-Meier. Cox proportional hazards models were used to identify the independent prognostic factors. An nN staging system considering both the LNM site and count was developed and evaluated by the area under the receiver operating characteristic curve (AUC).
In total, 1313 patients were included and split into training (n = 1033) and external validation (n = 280) cohorts. There were 342 (26.0%), 568 (43.3%) and 403 (30.7%) patients in groups A, B and C, respectively. The OS of patients with pararespiratory and patients with paradigestive LNM presented significant differences in the training and validation cohorts (P < 0.050). In the training cohort, LNM site was an independent prognostic factor (hazard ratio: 1.58, 95% confidence intervals: 1.41-1.77, P < 0.001). The nN staging definition: nN1 (1-2 positive pararespiratory/paradigestive LNs), nN2 (3-6 pararespiratory LNs or 1 pararespiratory with 1paradigestive LN), nN3 (3-6 LNs with ≥ 1 paradigestive LN), nN4 (≥ 7 LNs). Subsets of patients with different nN stages showed significant differences in OS (P < 0.050). The prognostic model of the nN staging system presented higher performance in the training and validation cohorts at 3-year OS (AUC, 0.725 and 0.751, respectively) and 5-year OS (AUC, 0.740 and 0.793, respectively) than the current N staging systems.
Compared to pararespiratory LNM, the presence of paradigestive LNM is associated with worse OS. The nN staging system revealed superior prognostic ability than current N staging systems.
淋巴结转移（LNM）部位可能影响食管鳞状细胞癌（ESCC）患者的预后。本研究旨在探讨肺旁和消化旁 LNM 的预后，并提出一种新的 N（nN）分期系统，该系统整合了 LNM 部位和数量。
这是一项多中心、大样本、回顾性队列研究，纳入了 2014 年 1 月至 2019 年 12 月期间来自中国三个研究所的 ESCC 伴 LNM 患者。患者被分为训练（两个研究所）和外部验证（一个研究所）队列。主要结局为 LNM 部位的生存差异和新的淋巴结分期系统的发展。采用 Kaplan-Meier 法评估肺旁 LNM 仅（A 组）、消化旁 LNM 仅（B 组）和两个部位均有 LNM（C 组）患者的总生存（OS）。采用 Cox 比例风险模型确定独立预后因素。采用受试者工作特征曲线（ROC）下面积（AUC）评估考虑 LNM 部位和数量的 nN 分期系统。
共纳入 1313 例患者，分为训练（n=1033）和外部验证（n=280）队列。A、B 和 C 组患者分别为 342（26.0%）、568（43.3%）和 403（30.7%）。在训练和验证队列中，肺旁和消化旁 LNM 患者的 OS 存在显著差异（P<0.050）。在训练队列中，LNM 部位是独立的预后因素（风险比：1.58，95%置信区间：1.41-1.77，P<0.001）。nN 分期定义：nN1（1-2 个阳性肺旁/消化旁 LNs）、nN2（3-6 个肺旁 LNs 或 1 个肺旁加 1 个消化旁 LN）、nN3（3-6 个 LNs 伴≥1 个消化旁 LN）、nN4（≥7 个 LNs）。不同 nN 分期的患者亚组在 OS 方面存在显著差异（P<0.050）。nN 分期系统的预后模型在训练和验证队列中，3 年 OS（AUC，分别为 0.725 和 0.751）和 5 年 OS（AUC，分别为 0.740 和 0.793）的表现均优于现行 N 分期系统。
与肺旁 LNM 相比，存在消化旁 LNM 与较差的 OS 相关。nN 分期系统显示出比现行 N 分期系统更好的预后能力。
