Abstract
BackgroundLymph node (LN)-related factors including the number of LN regions involved, the LN ratio (LNR), and the number of metastatic LNs are strong prognostic indicators for esophageal squamous cell carcinoma (ESCC) patients. Accurately staging LN involvement may improve the stratification of patients and guide the management of patients.MethodsA total of 688 potentially resectable patients who had regional LN metastases were enrolled in this retrospective study.ResultsESCC involving a single region was associated with better outcomes than that involving multiple regions (P < 0.001 for both PFS and OS). An increased number of metastatic LNs was significantly associated with reduced PFS and OS based on univariate analysis (P < 0.001). PFS and OS were significantly higher in patients with a lower cancer-involved LNR, with 5-year OS rates of 9.7% and 31.4% for patients with a lower and higher cancer-involved LNR, respectively. Based on multivariate analysis, patients with N1 LN involvement experienced longer survival than patients with N2 LN involvement (HR: 1.37; 95% CI: 1.12-1.68) or N3 LN involvement (HR: 1.96; 95% CI: 1.52-2.53). Higher LNR resulted in longer OS than lower LNR based on multivariate analysis (HR: 1.45; 95% CI: 1.15-1.84; P = 0.002).ConclusionsOur study has shown that not only the number of metastatic LNs but also the number of involved LN regions predicts outcomes after definitive surgery among Chinese patients with N-positive ESCC. LNR might serve as a powerful indicator that should be included in TNM staging for EC patients.
Highlights
There have been some improvements in the diagnosis and therapy of esophageal cancer (EC), it remains one of the leading causes of cancer-related mortality worldwide, resulting in 406,800 deaths annually [1]
An increased number of metastatic Lymph node (LN) was significantly associated with reduced Progression-free survival (PFS) and overall survival (OS) based on univariate analysis (P < 0.001)
PFS and OS were significantly higher in patients with a lower cancer-involved LN ratio (LNR), with 5year OS rates of 9.7% and 31.4% for patients with a lower and higher cancer-involved LNR, respectively
Summary
There have been some improvements in the diagnosis and therapy of esophageal cancer (EC), it remains one of the leading causes of cancer-related mortality worldwide, resulting in 406,800 deaths annually [1]. The American Joint Committee on Cancer (AJCC)/Union International Against Cancer (UICC) tumor node metastasis (TNM) cancer staging system has widely been used to stratify EC patients and to choose optimal treatment strategies. The 7th and most recent edition of the AJCC/UICC TNM classification was released in late 2009 [7] In this edition, N is defined as the number of regional LNs involved (N0, 0 nodes; N1, 1 to 2 nodes; N2, 3 to 6 nodes; and N3, more than 7 nodes). According to the 6th edition of the AJCC/ UICC TNM classification, N staging can be subclassified as the absence (N0) or presence (N1) of paraesophageal LN involvement in EC patients. Lymph node (LN)-related factors including the number of LN regions involved, the LN ratio (LNR), and the number of metastatic LNs are strong prognostic indicators for esophageal squamous cell carcinoma (ESCC) patients. Staging LN involvement may improve the stratification of patients and guide the management of patients
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