Pararespiratory and Paradigestive Lymph Node Metastases in Esophageal Squamous Cell Carcinoma to Predict Survival and Refine the N Staging System
Presented During:
Saturday, May 6, 2023: 8:00AM - Tuesday, May 9, 2023: 11:45AM
Los Angeles Convention Center
Posted Room Name:
Outside of Room 408
Abstract No:
PS060
Submission Type:
Abstract Submission
Authors:
DONG TIAN (1), Kai-Yuan Jiang (2), Yu-Shang Yang (1), Long-Qi Chen (1)
Institutions:
(1) West China Hospital, Sichuan University, Chengdu, China, (2) Tohoku University Graduate School of Medicine, Sendai, Japan
Submitting Author:
Dong Tian
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West China Hospital, Sichuan University
West China Hospital, Sichuan University
Co-Author(s):
Kai-Yuan Jiang
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Tohoku University Graduate School of Medicine
Tohoku University Graduate School of Medicine
Yu-Shang Yang
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West China Hospital, Sichuan University
West China Hospital, Sichuan University
Long-Qi Chen
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West China Hospital, Sichuan University
West China Hospital, Sichuan University
Presenting Author:
Dong Tian
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Abstract:
Objective: The lymph node metastasis (LNM) site may affect the prognosis of patients with esophageal squamous cell carcinoma (ESCC). However, it is still unclear whether ESCC patients with LNM around the respiratory system and digestive system have difference survival outcomes. This study aimed to investigate the prognoses of pararespiratory and paradigestive LNM and to propose a novel N (nN) staging system that integrates both the LNM site and count.
Methods: ESCC patients with LNM between January 2014 and December 2019 at three institutes were retrospectively reviewed and set in training (two institutes) and external validation (one institute) cohorts. Pararespiratory LN stations were defined as the site in cervical (station 1) and thoracic (stations 2, 3, 4, 5, 6, 7, 9, 10) regions, while paradigestive LN stations were defined as the thoracic and abdomen regions (stations 8, 15, 16, 17, 18, 19, 20). Kaplan-Meier and Cox proportional hazards models were used to analyze overall survival (OS) and prognosis. FactorMerger method with factor merge tree and survival plot was performed to determine the nN staging system. The performance of nN staging system was evaluated by the area under the receiver operating characteristic curve (AUC).
Results: In total, 1313 patients were included and split into training (n = 1033) and external validation (n = 280) cohorts. The OS of patients with pararespiratory and patients with paradigestive LNM presented significant differences in the training and validation cohorts (P < 0.050). In the training cohort, LNM site, sex, postoperative complications and T stage were independent prognostic factors (all P < 0.001). Age, surgical approach and tumor location were independent risk factors for paradigestive LNM (all P < 0.001). A nN staging system with four subsets that integrated both the site and count of LNM was developed. Subsets of patients with different nN stages showed significant differences in OS (P < 0.050). The prognostic model of the nN staging system presented higher performance in the training and validation cohorts at 3-year OS (AUC, 0.725 and 0.751, respectively) and 5-year OS (AUC, 0.740 and 0.793, respectively) than the current N staging systems.
Conclusions: Compared to pararespiratory LNM, the presence of paradigestive LNM is associated with worse OS. The nN staging system revealed superior prognostic ability than current N staging systems.
Methods: ESCC patients with LNM between January 2014 and December 2019 at three institutes were retrospectively reviewed and set in training (two institutes) and external validation (one institute) cohorts. Pararespiratory LN stations were defined as the site in cervical (station 1) and thoracic (stations 2, 3, 4, 5, 6, 7, 9, 10) regions, while paradigestive LN stations were defined as the thoracic and abdomen regions (stations 8, 15, 16, 17, 18, 19, 20). Kaplan-Meier and Cox proportional hazards models were used to analyze overall survival (OS) and prognosis. FactorMerger method with factor merge tree and survival plot was performed to determine the nN staging system. The performance of nN staging system was evaluated by the area under the receiver operating characteristic curve (AUC).
Results: In total, 1313 patients were included and split into training (n = 1033) and external validation (n = 280) cohorts. The OS of patients with pararespiratory and patients with paradigestive LNM presented significant differences in the training and validation cohorts (P < 0.050). In the training cohort, LNM site, sex, postoperative complications and T stage were independent prognostic factors (all P < 0.001). Age, surgical approach and tumor location were independent risk factors for paradigestive LNM (all P < 0.001). A nN staging system with four subsets that integrated both the site and count of LNM was developed. Subsets of patients with different nN stages showed significant differences in OS (P < 0.050). The prognostic model of the nN staging system presented higher performance in the training and validation cohorts at 3-year OS (AUC, 0.725 and 0.751, respectively) and 5-year OS (AUC, 0.740 and 0.793, respectively) than the current N staging systems.
Conclusions: Compared to pararespiratory LNM, the presence of paradigestive LNM is associated with worse OS. The nN staging system revealed superior prognostic ability than current N staging systems.
THORACIC:
Esophageal Cancer
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