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Lymph node ratio-based staging system for esophageal squamous cell carcinoma.
World J Gastroenterol. 2015 Jun 28; 21(24):7514-21.WJ

Abstract

AIM

To analyze a modified staging system utilizing lymph node ratio (LNR) in patients with esophageal squamous cell carcinoma (ESCC).

METHODS

Clinical data of 2011 patients with ESCC who underwent surgical resection alone between January 1995 and June 2010 at the Cancer Hospital of Shantou University Medical College were reviewed. The LNR, or node ratio (Nr) was defined as the ratio of metastatic LNs ompared to the total number of resected LNs. Overall survival between groups was compared with the log-rank test. The cutoff point of LNR was established by grouping patients with 10% increment in Nr, and then combining the neighborhood survival curves using the log-rank test. A new TNrM staging system, was constructed by replacing the American Joint Committee on Cancer (AJCC) N categories with the Nr categories in the new TNM staging system. The time-dependent receiver operating characteristic curves were used to evaluate the predictive performance of the seventh edition AJCC staging system and the TNrM staging system.

RESULTS

The median number of resected LNs was 12 (range: 4-44), and 25% and 75% interquartile rangeswere8 and 16. Patients were classified into four Nr categories with distinctive survival differences (Nr0: LNR = 0; Nr1: 0% < LNR ≤ 10%; Nr2: 10% < LNR ≤ 20%; and Nr3: LNR > 20%). From N categories to Nr categories, 557 patients changed their LN stage. The median survival time (MST) for the four Nr categories (Nr0-Nr3) was 155.0 mo, 39.0 mo, 28.0 mo, and 19.0 mo, respectively, and the 5-year overall survival was 61.1%, 41.1%, 33.0%, and 22.9%, respectively (P < 0.001). Overall survival was significantly different for the AJCC N categories when patients were subgrouped into 15 or more vs fewer than 15 examined nodes, except for the N3 category (P = 0.292). However, overall survival was similar when the patients in all four Nr categories were subgrouped into 15 or more vs fewer than 15 nodes. Using the time-dependent receiver operating characteristic, we found that the Nr category and TNrM stage had higher accuracy in predicting survival than the AJCC N category and TNM stage.

CONCLUSION

A staging system based on LNR may have better prognostic stratification of patients with ESCC than the current TNM system, especially for those undergoing limited lymphadenectomy.

Authors+Show Affiliations

Shao-Bin Chen, Hong-Rui Weng, Geng Wang, Di-Tian Liu, Yu-Ping Chen, Department of Thoracic Surgery, Cancer Hospital of Shantou University Medical College, Shantou 515031, Guangdong Province, China.Shao-Bin Chen, Hong-Rui Weng, Geng Wang, Di-Tian Liu, Yu-Ping Chen, Department of Thoracic Surgery, Cancer Hospital of Shantou University Medical College, Shantou 515031, Guangdong Province, China.Shao-Bin Chen, Hong-Rui Weng, Geng Wang, Di-Tian Liu, Yu-Ping Chen, Department of Thoracic Surgery, Cancer Hospital of Shantou University Medical College, Shantou 515031, Guangdong Province, China.Shao-Bin Chen, Hong-Rui Weng, Geng Wang, Di-Tian Liu, Yu-Ping Chen, Department of Thoracic Surgery, Cancer Hospital of Shantou University Medical College, Shantou 515031, Guangdong Province, China.Shao-Bin Chen, Hong-Rui Weng, Geng Wang, Di-Tian Liu, Yu-Ping Chen, Department of Thoracic Surgery, Cancer Hospital of Shantou University Medical College, Shantou 515031, Guangdong Province, China.Shao-Bin Chen, Hong-Rui Weng, Geng Wang, Di-Tian Liu, Yu-Ping Chen, Department of Thoracic Surgery, Cancer Hospital of Shantou University Medical College, Shantou 515031, Guangdong Province, China.Shao-Bin Chen, Hong-Rui Weng, Geng Wang, Di-Tian Liu, Yu-Ping Chen, Department of Thoracic Surgery, Cancer Hospital of Shantou University Medical College, Shantou 515031, Guangdong Province, China.

Pub Type(s)

Comparative Study
Journal Article

Language

eng

PubMed ID

26139998

Citation

Chen, Shao-Bin, et al. "Lymph Node Ratio-based Staging System for Esophageal Squamous Cell Carcinoma." World Journal of Gastroenterology, vol. 21, no. 24, 2015, pp. 7514-21.
Chen SB, Weng HR, Wang G, et al. Lymph node ratio-based staging system for esophageal squamous cell carcinoma. World J Gastroenterol. 2015;21(24):7514-21.
Chen, S. B., Weng, H. R., Wang, G., Zou, X. F., Liu, D. T., Chen, Y. P., & Zhang, H. (2015). Lymph node ratio-based staging system for esophageal squamous cell carcinoma. World Journal of Gastroenterology, 21(24), 7514-21. https://doi.org/10.3748/wjg.v21.i24.7514
Chen SB, et al. Lymph Node Ratio-based Staging System for Esophageal Squamous Cell Carcinoma. World J Gastroenterol. 2015 Jun 28;21(24):7514-21. PubMed PMID: 26139998.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Lymph node ratio-based staging system for esophageal squamous cell carcinoma. AU - Chen,Shao-Bin, AU - Weng,Hong-Rui, AU - Wang,Geng, AU - Zou,Xiao-Fang, AU - Liu,Di-Tian, AU - Chen,Yu-Ping, AU - Zhang,Hao, PY - 2014/11/15/received PY - 2015/02/06/revised PY - 2015/03/18/accepted PY - 2015/7/4/entrez PY - 2015/7/4/pubmed PY - 2016/3/17/medline KW - Cancer staging KW - Esophageal squamous cell carcinoma KW - Esophagectomy KW - Lymph node ratio KW - Prognosis SP - 7514 EP - 21 JF - World journal of gastroenterology JO - World J Gastroenterol VL - 21 IS - 24 N2 - AIM: To analyze a modified staging system utilizing lymph node ratio (LNR) in patients with esophageal squamous cell carcinoma (ESCC). METHODS: Clinical data of 2011 patients with ESCC who underwent surgical resection alone between January 1995 and June 2010 at the Cancer Hospital of Shantou University Medical College were reviewed. The LNR, or node ratio (Nr) was defined as the ratio of metastatic LNs ompared to the total number of resected LNs. Overall survival between groups was compared with the log-rank test. The cutoff point of LNR was established by grouping patients with 10% increment in Nr, and then combining the neighborhood survival curves using the log-rank test. A new TNrM staging system, was constructed by replacing the American Joint Committee on Cancer (AJCC) N categories with the Nr categories in the new TNM staging system. The time-dependent receiver operating characteristic curves were used to evaluate the predictive performance of the seventh edition AJCC staging system and the TNrM staging system. RESULTS: The median number of resected LNs was 12 (range: 4-44), and 25% and 75% interquartile rangeswere8 and 16. Patients were classified into four Nr categories with distinctive survival differences (Nr0: LNR = 0; Nr1: 0% < LNR ≤ 10%; Nr2: 10% < LNR ≤ 20%; and Nr3: LNR > 20%). From N categories to Nr categories, 557 patients changed their LN stage. The median survival time (MST) for the four Nr categories (Nr0-Nr3) was 155.0 mo, 39.0 mo, 28.0 mo, and 19.0 mo, respectively, and the 5-year overall survival was 61.1%, 41.1%, 33.0%, and 22.9%, respectively (P < 0.001). Overall survival was significantly different for the AJCC N categories when patients were subgrouped into 15 or more vs fewer than 15 examined nodes, except for the N3 category (P = 0.292). However, overall survival was similar when the patients in all four Nr categories were subgrouped into 15 or more vs fewer than 15 nodes. Using the time-dependent receiver operating characteristic, we found that the Nr category and TNrM stage had higher accuracy in predicting survival than the AJCC N category and TNM stage. CONCLUSION: A staging system based on LNR may have better prognostic stratification of patients with ESCC than the current TNM system, especially for those undergoing limited lymphadenectomy. SN - 2219-2840 UR - https://www.unboundmedicine.com/medline/citation/26139998/Lymph_node_ratio_based_staging_system_for_esophageal_squamous_cell_carcinoma_ L2 - https://www.wjgnet.com/1007-9327/full/v21/i24/7514.htm DB - PRIME DP - Unbound Medicine ER -