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The N-classification for esophageal cancer staging: should it be based on number, distance, or extent of the lymph node metastasis?
World J Surg. 2011 Jun; 35(6):1303-10.WJ

Abstract

BACKGROUND

The recently published AJCC-TNM staging system for esophageal carcinoma made an obvious modification on N-classification based on the number of metastatic regional lymph nodes (LN). However, this classification might ignore the site at which these LNs occur, a factor that might be even more important in reflecting patients' prognosis.

METHODS

A retrospective study of 236 patients with carcinoma of thoracic esophagus who underwent esophagectomy between 1984 and 1989 with each at least six LNs removed was conducted, with a 10-year follow-up rate of 92.4%. The proposed scheme for N-classification according to the number (0, 1-2, 3-6, ≥7; N0-3), distance (0, 1, 2, 3 stations; S0-3), or extent (0, 1, and 2 fields; F0-2) of LN involvement was evaluated by univariate and multivariate survival analysis.

RESULTS

The LN metastasis was identified in 112 patients, revealing a poorer 5-year survival in this patient group when compared to patients without node involvement. Cox regression analysis revealed that the number and distance of LN metastases and the number of metastasis fields were factors significantly influencing survival. When these factors were further analyzed by univariate log-rank test, no significant difference in survival existed between N2 and N3 patients, or among S1, S2, and S3 patients. When patients were grouped according to the extent of LN metastasis, significant differences in survival were observed overall and between each subgroup.

CONCLUSIONS

Refining the current N-classification for esophageal cancer according to the extent of LN metastasis, rather than by number alone, might be a better means of staging that could subgroup patients more effectively and result in different rates of survival.

Authors+Show Affiliations

Department of Thoracic Surgery, West China Hospital of Sichuan University, No. 37 Guoxue Alley, Chengdu, Sichuan, 610041, China.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

21452071

Citation

Xu, Qi-Rong, et al. "The N-classification for Esophageal Cancer Staging: Should It Be Based On Number, Distance, or Extent of the Lymph Node Metastasis?" World Journal of Surgery, vol. 35, no. 6, 2011, pp. 1303-10.
Xu QR, Zhuge XP, Zhang HL, et al. The N-classification for esophageal cancer staging: should it be based on number, distance, or extent of the lymph node metastasis? World J Surg. 2011;35(6):1303-10.
Xu, Q. R., Zhuge, X. P., Zhang, H. L., Ping, Y. M., & Chen, L. Q. (2011). The N-classification for esophageal cancer staging: should it be based on number, distance, or extent of the lymph node metastasis? World Journal of Surgery, 35(6), 1303-10. https://doi.org/10.1007/s00268-011-1015-9
Xu QR, et al. The N-classification for Esophageal Cancer Staging: Should It Be Based On Number, Distance, or Extent of the Lymph Node Metastasis. World J Surg. 2011;35(6):1303-10. PubMed PMID: 21452071.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - The N-classification for esophageal cancer staging: should it be based on number, distance, or extent of the lymph node metastasis? AU - Xu,Qi-Rong, AU - Zhuge,Xue-Peng, AU - Zhang,He-Lin, AU - Ping,Yu-Min, AU - Chen,Long-Qi, PY - 2011/4/1/entrez PY - 2011/4/1/pubmed PY - 2011/9/17/medline SP - 1303 EP - 10 JF - World journal of surgery JO - World J Surg VL - 35 IS - 6 N2 - BACKGROUND: The recently published AJCC-TNM staging system for esophageal carcinoma made an obvious modification on N-classification based on the number of metastatic regional lymph nodes (LN). However, this classification might ignore the site at which these LNs occur, a factor that might be even more important in reflecting patients' prognosis. METHODS: A retrospective study of 236 patients with carcinoma of thoracic esophagus who underwent esophagectomy between 1984 and 1989 with each at least six LNs removed was conducted, with a 10-year follow-up rate of 92.4%. The proposed scheme for N-classification according to the number (0, 1-2, 3-6, ≥7; N0-3), distance (0, 1, 2, 3 stations; S0-3), or extent (0, 1, and 2 fields; F0-2) of LN involvement was evaluated by univariate and multivariate survival analysis. RESULTS: The LN metastasis was identified in 112 patients, revealing a poorer 5-year survival in this patient group when compared to patients without node involvement. Cox regression analysis revealed that the number and distance of LN metastases and the number of metastasis fields were factors significantly influencing survival. When these factors were further analyzed by univariate log-rank test, no significant difference in survival existed between N2 and N3 patients, or among S1, S2, and S3 patients. When patients were grouped according to the extent of LN metastasis, significant differences in survival were observed overall and between each subgroup. CONCLUSIONS: Refining the current N-classification for esophageal cancer according to the extent of LN metastasis, rather than by number alone, might be a better means of staging that could subgroup patients more effectively and result in different rates of survival. SN - 1432-2323 UR - https://www.unboundmedicine.com/medline/citation/21452071/The_N_classification_for_esophageal_cancer_staging:_should_it_be_based_on_number_distance_or_extent_of_the_lymph_node_metastasis L2 - https://dx.doi.org/10.1007/s00268-011-1015-9 DB - PRIME DP - Unbound Medicine ER -