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Annals of Surgical Oncology
Erschienen in:

18.03.2021 | Thoracic Oncology

Prognostic Role of Nodal Skip Metastasis in Thoracic Esophageal Squamous Cell Carcinoma: A Large-Scale Multicenter Study

verfasst von: Qi-Xin Shang, MD, Yu-Shang Yang, MD, PhD, Li-Yan Xu, 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, Zhi-Wei Fan, PhD, Yong Yuan, MD, PhD, Long-Qi Chen, MD, PhD

Erschienen in: Annals of Surgical Oncology | Ausgabe 11/2021

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Abstract

Background

Nodal-skip metastasis (NSM) is found in esophageal squamous cell carcinoma (ESCC), but its prognostic role is controversial. This study aimed to investigate the prognostic value of NSM for thoracic ESCC patients.

Methods

Categorization of NSM was according to the N groupings of Japan Esophagus Society (JES) staging system, which is dependent on tumor location. Using the Kaplan–Meier method and Cox-regression analysis, this study retrospectively analyzed the overall survival (OS) for 2325 ESCC patients after radical esophagectomy at three high-volume esophageal cancer centers. Predictive models also were constructed.

Results

The overall NSM rate was 20% (229/1141): 37.4% in the in upper, 12.9% in the middle, and 22.2% in the lower thoracic ESCC. The patients with NSM always had a better prognosis than those without NSM. Furthermore, NSM was an independent prognostic factor for thoracic ESCC patients (hazard ratio [HR], 0.633; 95% confidence interval [CI], 0.499–0.803; P < 0.001). By integrating the prognostic values of NSM and N stage, the authors proposed the new N staging system. The categories defined by the new N staging system were more homogeneous in terms of OS than those defined by the current N system. Moreover, the new N system was shown to be an independent prognostic factor also for thoracic ESCC patients (HR, 1.607; 95% CI, 1.520–1.700; P < 0.001). Overall, the new N system had slightly better homogeneity, discriminatory ability, and monotonicity of gradient than the current N system.

Conclusions

This study emphasized the prognostic power of NSM and developed a modified node-staging system to improve the efficiency of the current International Union for Cancer Control (UICC)/American Joint Committee on Cancer (AJCC) N staging system.
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Metadaten
Titel
Prognostic Role of Nodal Skip Metastasis in Thoracic Esophageal Squamous Cell Carcinoma: A Large-Scale Multicenter Study
verfasst von
Qi-Xin Shang, MD
Yu-Shang Yang, MD, PhD
Li-Yan Xu, 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
Zhi-Wei Fan, PhD
Yong Yuan, MD, PhD
Long-Qi Chen, MD, PhD
Publikationsdatum
18.03.2021
Verlag
Springer International Publishing
Erschienen in
Annals of Surgical Oncology / Ausgabe 11/2021
Print ISSN: 1068-9265
Elektronische ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-020-09509-z

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