Proposed Modification of Nodal Staging as an Alternative to the Seventh Edition of the American Joint Committee on Cancer Tumor-Node-Metastasis Staging System Improves the Prognostic Prediction in the Resected Esophageal Squamous-Cell Carcinoma

Retrospective study of 917 patients undergoing esophagectomy for squamous cell carcinoma at a single hospital in China. In the 7th version of the AJCC staging system for esophageal cancer, nodal stage (N stage) is based solely on the number of lymph node (LN) metastases. However, an updated staging system that includes the extent of LN metastases is proposed to determine if patients can be better stratified according to stage and subsequent survival. The authors hypothesized that given the same number of LNs, the prognosis may differ between patients whose metastatic LNs are contained in one station versus multiple stations. The current AJCC staging system used global data from 4,627 patients, but only 40% of these patients had squamous cell carcinoma. All patients in this study underwent transthoracic en-bloc esophagectomy with mediastinal and abdominal two-field lymphadenectomies. Four revised N stages were proposed: r-N0, 0 station, r-N1, 1 station, r-N2, 2 stations, r-N3, 3 stations based on Casson's LN drainage map. There was improvement in discrimination in terms of survival between those with r-N2 versus r-N3 and also between stages IIIB and IIIC using the revised staging system.