Zhao Zongxing, Wang Hongmin, Liu Yajing, Li Minghuan, Li Mingjun
Department of Radiation Oncology, Liaocheng People's Hospital, Shandong First Medical University, Liaocheng, Shandong, China.
Joint Laboratory for Translational Medicine Research, Liaocheng People's Hospital, Shandong First Medical University, Liaocheng, Shandong, China.
Front Oncol. 2023 Oct 9;13:1234426. doi: 10.3389/fonc.2023.1234426. eCollection 2023.
This study aimed to evaluate the feasibility of a combination of abdominal lymph node (LN) metastasis and the number of LNs in esophageal squamous cell carcinoma (ESCC) patients to optimize its clinical nodal staging.
A retrospective study, including a total of 707 ESCC patients treated with definitive radiotherapy, was conducted at two participating institutes. Different combinations of LN variables, including abdominal LN metastasis (R1: no-abdominal LN metastasis; R2: abdominal LN metastasis), were further analyzed to propose a potential revised nodal (rN) staging.
The multivariate analyses showed that the number of metastatic LN and abdominal LN metastasis were independent prognostic factors for the overall survival (OS). The results showed no significant differences in the OS between the N2 patients with abdominal LN metastasis and N3 patients. The OS of the stage III patients with abdominal LN metastasis was not significantly different from those with stage IVa. The N3R1 and N1-2R2 had similar hazard ratios (HRs). The N1R1 subset was defined as rN1, the N2R1 subset was defined as rN2, and the N3R1-2 and N1-2R2 subsets were defined as rN3. The HRs of OS of the rN2 and rN3 groups increased subsequently. The rN stage could identify the differences in the OS times of each subgroup based on the 8th AJCC cN staging or the 11th JES N staging.
The rN staging, including the number of metastatic LNs and abdominal LN metastasis, might serve as a potential prognostic predictor for non-surgical patients with ESCC.
本研究旨在评估将腹主动脉旁淋巴结（LN）转移情况与食管鳞状细胞癌（ESCC）患者的淋巴结数量相结合以优化其临床淋巴结分期的可行性。
在两个参与机构进行了一项回顾性研究，共纳入707例接受根治性放疗的ESCC患者。进一步分析了包括腹主动脉旁淋巴结转移（R1：无腹主动脉旁淋巴结转移；R2：腹主动脉旁淋巴结转移）在内的不同淋巴结变量组合，以提出潜在的修订淋巴结（rN）分期。
多因素分析显示，转移淋巴结数量和腹主动脉旁淋巴结转移是总生存期（OS）的独立预后因素。结果显示，腹主动脉旁淋巴结转移的N2患者与N3患者的OS无显著差异。腹主动脉旁淋巴结转移的III期患者与IVa期患者的OS无显著差异。N3R1和N1-2R2的风险比（HR）相似。将N1R1亚组定义为rN1，N2R1亚组定义为rN2，N3R1-2和N1-2R2亚组定义为rN3。rN2和rN3组的OS的HR随后增加。rN分期可以根据第8版美国癌症联合委员会（AJCC）cN分期或第11版日本食管癌学会（JES）N分期识别各亚组OS时间的差异。
包括转移淋巴结数量和腹主动脉旁淋巴结转移的rN分期可能是ESCC非手术患者潜在的预后预测指标。
