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Lymph Node Station-Based Nodal Staging System for Esophageal Squamous Cell Carcinoma: A Large-Scale Multicenter Study

Yong Yuan MD, PhD, Hyokyoung G. Hong PhD, Xiaoxi Zeng MD, PhD, Li-Yan Xu MD, Yu-Shang Yang MD, Qi-Xin Shang MD, Hong Yang MD, PhD, Yin Li MD, PhD, Yi Li PhD, Zhi-Yong Wu MD, Jian-Hua Fu MD, Xiao-Dong Yao MD, Xiu-E Xu MD, Jian-Yi Wu MD, Long-Qi Chen MD, PhD
Thoracic Oncology
Volume 26, Issue 12 / November , 2019



The American Joint Committee on Cancer (AJCC) nodal staging for esophageal squamous cell carcinoma (ESCC) has been defined by the number of metastatic lymph nodes (N system). However, the precise counting of individual positive lymph nodes is difficult and unreliable in some clinical settings, which calls for a more available and reliable system. This study examined the performance of a newly proposed nodal staging category, termed the S system, based on the number of metastatic lymph node stations.


Using the Kaplan–Meier method and Cox-regression analysis, this study retrospectively analyzed the overall survival (OS) of 2285 ESCC patients who underwent esophagectomy in three major China hospitals. Predictive models were constructed, and C-indices were computed to evaluate the discriminatory power of the S system, and to compare it with the N system.


The categories defined by the S system were more homogeneous in terms of OS than those defined by the N system. Overall, the S system had a slightly better C-index (p = 0.659) than the N system ((p = 0.658). Subgroup analyses also showed that the C-index of the S system was slightly better than that of the N system for each subgroup of sex and age, but the two were comparable for each subgroup defined by the tumor location.


The S system demonstrated a competing prognostic performance compared with the current AJCC N system. Due to the relatively easy accessibility of the number of metastatic lymph node stations, the S system may offer an easier option for cancer staging without a loss of discriminative power.

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