Numeric pathologic lymph node classification shows prognostic superiority to topographic pN classification in...

Area of Science:

• Oncology
• Surgical Pathology
• Cancer Staging

Background:

• Current esophageal squamous cell carcinoma staging relies on metastatic node count, neglecting anatomical distribution.
• The 8th tumor node metastasis (TNM) staging system is numeric-based.
• The 11th Japan Esophageal Society (JES) staging system is topography-based.

Purpose of the Study:

• Compare the prognostic capability of the 8th TNM pathologic lymph node staging system versus the 11th JES staging system.
• Assess staging system accuracy for overall survival, recurrence-free survival, and cancer-specific survival in esophageal squamous cell carcinoma.

Main Methods:

• Retrospective review of 289 esophageal squamous cell carcinoma patients undergoing esophagectomy with extended lymph node dissection (2006-2016).
• Comparison of discrimination abilities using C-statistics for overall survival, recurrence-free survival, and cancer-specific survival.
• Analysis of median dissected and metastatic lymph node counts.

Main Results:

• The 8th TNM system demonstrated superior accuracy for overall survival (C-statistic: 0.69 vs. 0.65) and cancer-specific survival (C-statistic: 0.78 vs. 0.72) compared to the JES system.
• Recurrence rates increased with higher 8th TNM pathologic lymph node stages.
• Stratification by the topography-based JES system was not feasible for recurrence patterns.

Conclusions:

• Numeric nodal staging, exemplified by the 8th TNM system, is essential for stratifying oncologic outcomes in esophageal squamous cell carcinoma.
• This holds true even in cohorts with adequate lymph node harvesting.
• The 8th TNM system offers improved prognostic capability over the JES system.