PS60. Pararespiratory and Paradigestive Lymph Node Metastases in Esophageal Squamous Cell Carcinoma to Predict Survival and Refine the N Staging System
West China Hospital, Sichuan University
Chengdu, Sichuan
China - Contact Me
Dr. Dong Tian is a thoracic surgeon in China. He graduated as a Ph.D. Fellow (Thoracic Surgery) from The University of Tokyo (2018-2022, Tokyo, Japan), supervised by Prof. Jun Nakajima and Prof. Masaaki Sato. From 2015-2016, he studied as a Visiting Fellow at The University of Toledo Medical Center (Ohio, USA, supervised by Dr. Thomas Schwann). After that, he studied at Kyoto University (Kyoto, Japan) as a Research Fellow (lung transplantation) for one year (supervised by Prof. Hiroshi Date and Prof. Toyofumi Fengshi Chen-Yoshikawa). After that, he was honored by AATS Foundation and visited Toronto General Hospital as a Training Fellow for LTx (Toronto, Canada, supervised by Dr. Shaf Keshavjee). He finished his Advanced Clinical Training (Thoracic Surgery and Gastroesophageal Surgery) at The University of Tokyo Hospital (supervised by Prof. Jun Nakajima and Prof. Yasuyuki Seto).
His main clinical and research interests focus on:
- Lung transplantation (rat model, graft rejection, Ex vivo lung perfusion, ischemia-reperfusion injury, etc.)
- Esophageal cancer (lymph node metastasis, prognosis, risk factors, conversion surgery, neoadjuvant therapy, salvage treatment, etc.)
- Thymic epithelial tumors (prognostic factors, survival outcomes, etc.)
- Lung cancer (lymph node metastasis, advanced stage tumors, prognostic factors, etc.)
- Multimodality treatment of thoracic disease
- Radiomics, artificial intelligence, etc.
Description
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.