Proposed revision of N categories to the 8th edition of the AJCC‐TNM staging system for non‐surgical esophageal squamous cell cancer

• Published in: Cancer science 2019-02, Vol.110 (2), p.717-725
• Main Authors: Hu, Kai, Kang, Ning, Liu, Yang, Guo, Dong, Jing, Wang, Lu, Jiamei, Tan, Tianmeng, Lv, Caitiao, Deng, Yuyan, Long, Jianxiong, Wang, Rensheng, Yu, Jinming
• Format: Article
• Language: English
• Subjects: Abdomen; AJCC‐TNM staging system; Cancer; Cancer therapies; Carcinoma, Squamous Cell - pathology; Cervix; Endoscopy; Esophageal cancer; Esophageal Neoplasms - pathology; esophageal squamous cell cancer; Esophageal Squamous Cell Carcinoma - pathology; Esophagus; Female; Humans; Lymph nodes; Lymph Nodes - pathology; Lymphatic Metastasis - pathology; Lymphatic system; Male; Medical prognosis; Metastases; Metastasis; Middle Aged; N category; Neoplasm Staging - methods; non‐surgical; Original; Patients; Prognosis; Radiation therapy; Retrospective Studies; Risk Factors; Surgery; Survival Rate; Thorax; Ultrasonic imaging
• ISSN: 1347-9032; 1349-7006
• DOI: 10.1111/cas.13891

The 8th edition of the American Joint Committee on Cancer Tumor‐Node‐Metastasis (AJCC‐TNM) staging system for esophageal cancer (EC) retained the definition of N categories based on the number of metastatic lymph nodes (LN). However, it is difficult to accurately determine the number of metastatic LN without surgery. This study aimed to propose a revision to the N categories of the 8th edition AJCC‐TNM staging system that makes staging easier to perform and better represents the prognosis of non‐surgical esophageal squamous cell cancer (ESCC). We retrospectively reviewed the data of 336 patients with ESCC. The revised N categories were based on the anatomic regions of LN metastasis (cervix, thorax and abdomen). Survival was analyzed using the Kaplan‐Meier method and compared using the log‐rank test. Multivariate analyses were performed using the Cox proportional hazard model. Survival differences were adequately discriminated when the revised N categories were used. Subgroup analyses by T stage showed significant difference in overall survival between the revised N categories. Multivariate analyses demonstrated that T stage, revised N category, age, sex and treatment modality were independent risk factors, with the revised N category being the most significant variable. The revised N categories determined in this study can be used to fill gaps in the staging system for patients with non‐surgical ESCC, which can help clinicians to make better treatment decisions and more effectively predict patient prognoses. Future large‐scale studies are required to validate these results. The 8th edition of the AJCC‐TNM staging system is generally not applicable for patients with non‐surgical EC because it is difficult to accurately evaluate lymph node metastasis without surgery. The revised N categories based on the anatomic regions of LN metastasis (cervix, thorax and abdomen) can accurately predict the survival of patients with non‐surgical ESCC and are, thus, applicable in clinical practice.