Li Kexun, Lu Simiao, Du Kunyi, Wang Chenghao, He Wenwu, Wang Qifeng, Han Yongtao, Leng Xuefeng, Peng Lin
Department of Thoracic Surgery.
Department of Radiation Oncology, Sichuan Clinical Research Center for Cancer, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, Affiliated Cancer Hospital of University of Electronic Science and Technology of China (Sichuan Cancer Hospital), Chengdu, China.
Int J Surg. 2025 Feb 1;111(2):1735-1748. doi: 10.1097/JS9.0000000000002188.
Esophageal squamous cell carcinoma (ESCC) poses a substantial healthcare challenge, particularly in areas such as East Asia. The pathologic nodal (pN) stage of ESCC remains a controversial factor. Accurately predicting overall survival (OS) after esophagectomy is crucial for treatment planning and improving treatment outcomes.
An analysis was conducted using data from Esophageal Cancer Case Management Database of Sichuan Cancer Hospital and Institute, spanning from January 2010 to December 2017. Our study aimed to examine the clinicopathological characteristics, lymph node resection at individual stations, and treatment details of patients with ESCC who underwent esophagectomy. In addition, a novel nodal stage (N stage) was based on the number of lymph node metastasis (LNM) stations, and a prediction model for OS was devised using the pN stage and the newly proposed N stage.
After analyzing 49 indicators through univariate and multifactorial analyses, 25 of the most significant factors affecting OS after esophagectomy were identified. Further analysis using least absolute shrinkage and selection operator regression revealed six key factors. Models were developed based on the pN stage and the newly introduced N stage. Evaluation of the area under the curve indicated that Model 2 exhibited slightly superior clinical utility compared to Model 1.
Our study demonstrates that the newly introduced N stage, based on the number of LNM stations, exhibits comparable performance to the current American Joint Committee on Cancer/Union for International Cancer Control pN system, with a slight advantageous edge.
食管鳞状细胞癌（ESCC）带来了重大的医疗挑战，尤其是在东亚等地区。ESCC的病理淋巴结（pN）分期仍然是一个有争议的因素。准确预测食管切除术后的总生存期（OS）对于治疗规划和改善治疗结果至关重要。
使用四川省肿瘤医院和研究所食管癌病例管理数据库2010年1月至2017年12月的数据进行分析。我们的研究旨在检查接受食管切除术的ESCC患者的临床病理特征、各站淋巴结切除情况及治疗细节。此外，基于淋巴结转移（LNM）站数建立了一种新的淋巴结分期（N分期），并使用pN分期和新提出的N分期设计了OS预测模型。
通过单因素和多因素分析对49项指标进行分析后，确定了25个影响食管切除术后OS的最重要因素。使用最小绝对收缩和选择算子回归进行进一步分析，发现了6个关键因素。基于pN分期和新引入的N分期建立了模型。曲线下面积评估表明，模型2的临床实用性略优于模型1。
我们的研究表明，基于LNM站数新引入的N分期与当前美国癌症联合委员会/国际癌症控制联盟pN系统表现相当，且略有优势。
