Lymph Node Station-Based Nodal Staging System for Esophageal Squamous Cell Carcinoma: A Large-Scale Multicenter Study

Area of Science:

• Oncology
• Cancer Staging
• Esophageal Cancer Research

Background:

• Current American Joint Committee on Cancer (AJCC) nodal staging for esophageal squamous cell carcinoma (ESCC) relies on counting metastatic lymph nodes (N system).
• Precise lymph node counting can be difficult and unreliable in clinical practice.
• A more accessible and reliable staging system is needed for ESCC.

Purpose of the Study:

• To evaluate a novel nodal staging system for ESCC based on the number of metastatic lymph node stations (S system).
• To compare the prognostic performance of the S system against the established AJCC N system.

Main Methods:

• Retrospective analysis of overall survival (OS) in 2285 ESCC patients who underwent esophagectomy.
• Utilized Kaplan-Meier method and Cox-regression analysis for survival analysis.
• Constructed predictive models and computed C-indices to assess discriminatory power.

Main Results:

• The S system categories exhibited greater homogeneity in OS compared to the N system categories.
• The S system demonstrated a slightly superior C-index (0.659) versus the N system (0.658).
• Subgroup analyses indicated a slight advantage for the S system in predicting survival across different sex and age groups.

Conclusions:

• The S system offers comparable prognostic performance to the current AJCC N system for ESCC.
• The S system's reliance on the number of metastatic lymph node stations makes it easier to implement.
• This system presents a potentially simpler alternative for cancer staging without sacrificing discriminative ability.