Prognostic impact of different lymph node staging systems in patients with esophageal squamous cell carcinoma
Peinan Chen1, Tongtong Ren2, Yishuo Gao2
1Department of Thoracic Surgery, The Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, 127 Dongming Road, Jinshui District, Zhengzhou, 450008, Henan, China.
Background:
Esophageal squamous cell carcinoma (ESCC) is an aggressive malignancy with poor prognosis. Accurate lymph node (LN) staging is vital for prognostication. This study compared accuracy of 5 LN staging systems for predicting long- and short-term outcomes.
Methods:
An ambispective cohort study included 1803 ESCC patients who underwent esophagectomy between January 2015 and December 2016, with follow-up until July 2022. Long-term outcomes were overall survival (OS) and disease-free survival (DFS). Short-term outcomes included postoperative complications. Kaplan-Meier and log-rank tests compared survival, Cox regression assessed OS/DFS, and logistic regression analyzed complications. Prognostic accuracy was compared using Akaike Information Criterion (AIC), concordance index (C-index), and area under the curve (AUC).
Results:
Cox regression analysis demonstrated that pN (HR = 4.583, 95% CI 3.412-6.155), lymph node ratio (LNR) (HR = 5.234, 95% CI 3.936-6.950), log odds of positive lymph nodes (LODDS) (HR = 3.236, 95% CI 2.678-3.910), negative lymph nodes (HR = 0.686, 95% CI 0.560-0.840), and resected lymph nodes (HR = 0.791, 95% CI 0.637-0.980) were associated with OS in ESCC patients, with consistent findings observed for DFS. pN, LNR, and LODDS were associated with postoperative complications. LNR had the best long-term prognostic performance (5-year OS AUC = 0.791, 5-year DFS AUC = 0.766), while LODDS was superior for predicting short-term outcomes (AUC = 0.731).
Conclusion:
LNR was the most accurate staging system for long-term prognosis, and LODDS best predicted short-term outcomes in ESCC. These findings may refine LN staging and prognostication in ESCC.
