Surgical endoscopy · 2025
Prognostic impact of different lymph node staging systems in patients with esophageal squamous cell carcinoma.
СтатьяСравнительное исследованиеПоддержка исследования: вне правительства СШАНазвание и аннотация: Перевод пока не подготовлен
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Chen Peinan, Ren Tongtong, Gao Yishuo, Wu Ning, Liu Qi, Jia Xiaocan, Yu Yongkui
Аннотация
BACKGROUND: Esophageal squamous cell carcinoma (ESCC) is an aggressive malignancy with poor prognosis. Accurate lymph node (LN) staging is vital for prognostication. This study compared accuracy of 5 LN staging systems for predicting long- and short-term outcomes.
METHODS: An ambispective cohort study included 1803 ESCC patients who underwent esophagectomy between January 2015 and December 2016, with follow-up until July 2022. Long-term outcomes were overall survival (OS) and disease-free survival (DFS). Short-term outcomes included postoperative complications. Kaplan-Meier and log-rank tests compared survival, Cox regression assessed OS/DFS, and logistic regression analyzed complications. Prognostic accuracy was compared using Akaike Information Criterion (AIC), concordance index (C-index), and area under the curve (AUC).
RESULTS: Cox regression analysis demonstrated that pN (HR = 4.583, 95% CI 3.412-6.155), lymph node ratio (LNR) (HR = 5.234, 95% CI 3.936-6.950), log odds of positive lymph nodes (LODDS) (HR = 3.236, 95% CI 2.678-3.910), negative lymph nodes (HR = 0.686, 95% CI 0.560-0.840), and resected lymph nodes (HR = 0.791, 95% CI 0.637-0.980) were associated with OS in ESCC patients, with consistent findings observed for DFS. pN, LNR, and LODDS were associated with postoperative complications. LNR had the best long-term prognostic performance (5-year OS AUC = 0.791, 5-year DFS AUC = 0.766), while LODDS was superior for predicting short-term outcomes (AUC = 0.731).
CONCLUSION: LNR was the most accurate staging system for long-term prognosis, and LODDS best predicted short-term outcomes in ESCC. These findings may refine LN staging and prognostication in ESCC.
METHODS: An ambispective cohort study included 1803 ESCC patients who underwent esophagectomy between January 2015 and December 2016, with follow-up until July 2022. Long-term outcomes were overall survival (OS) and disease-free survival (DFS). Short-term outcomes included postoperative complications. Kaplan-Meier and log-rank tests compared survival, Cox regression assessed OS/DFS, and logistic regression analyzed complications. Prognostic accuracy was compared using Akaike Information Criterion (AIC), concordance index (C-index), and area under the curve (AUC).
RESULTS: Cox regression analysis demonstrated that pN (HR = 4.583, 95% CI 3.412-6.155), lymph node ratio (LNR) (HR = 5.234, 95% CI 3.936-6.950), log odds of positive lymph nodes (LODDS) (HR = 3.236, 95% CI 2.678-3.910), negative lymph nodes (HR = 0.686, 95% CI 0.560-0.840), and resected lymph nodes (HR = 0.791, 95% CI 0.637-0.980) were associated with OS in ESCC patients, with consistent findings observed for DFS. pN, LNR, and LODDS were associated with postoperative complications. LNR had the best long-term prognostic performance (5-year OS AUC = 0.791, 5-year DFS AUC = 0.766), while LODDS was superior for predicting short-term outcomes (AUC = 0.731).
CONCLUSION: LNR was the most accurate staging system for long-term prognosis, and LODDS best predicted short-term outcomes in ESCC. These findings may refine LN staging and prognostication in ESCC.