A Comparative Study Of Different N Staging Methods In Esophageal Cancer Patients With Lymph Node Metastasis After Two-and-a-half Field Surgery

Objective:To compare N staging of AJCC?JES esophageal cancer staging system and LNR?the extent of LN involvement in the prognosis evaluation of postoperative patients after operation and discussion best of other methodsMethods:A retrospective study of 101 patients with carcinoma of thoracic esophagus who underwent esophagectomy of two and a half field and confirmed to be with lymph node metastasis between 2014 and 2016 in Fujian provincial hospital was conducted,with 8 cases lost to follow-up,2 cases of small cell carcinoma,1 case of gland scale cancer,1 case of basal cell carcinoma,1 case of neuroendocrine carcinoma,1 case of spindle cell carcinoma,2 cases of preoperative chemotherapy and 4 case hard to stage excluded,and ultimately 80 patients were included in the analysis.This group of patients are staged respectively according to the eighth edition UICC/AJCC staging system,the eleventh edition of N staging of JES,lymph node metastasis rate(LNR divided into L1:0.2 or less,L2:0.2 ~ 0.5,L3: > 0.5),lymph node metastasis area to differentiate [N0(those without LN metastasis),N1(transferred to one area),N2(transferred to two area),N3(transferred to the three area)],besides AJCC and JES staging systems were used to divide these patients into IIB,IIIA,IIIB,IVA,and II,III,IVA.Kaplan-Meier method was used for survival analysis,and log-rank method was used for significance test.Results: According to UICC/AJCC esophageal cancer staging system: there was no statistically significant difference in survival between N1 and N2(?2 = 1.497,P = 0.221),There was a significant difference between N2 and N3,(?2 = 4.231,P = 0.04),There was a significant difference between IIIB and IVA(?2 = 7.432,P = 0.006).According to JES esophageal cancer staging system: there was no statistically significant difference in survival between N1 and N2(?2 = 1.956,P = 0.162),N2 and N3(?2 = 0.209,P = 0.533),N3 and N4(?2 = 0.240,P = 0.642),There was a significant difference between II and III(?2 = 4.568,P = 0.033),besides III and IVA,(?2 = 7.869,P = 0.005).Conclusion: For patients with lymph node metastasis,AJCC and JES staging method,simply considering N stage,are not good at predicting the prognosis of patients,when considering the depth of the tumor infiltration,using total stage,both can well predict the prognosis of patients,but the prognosis of N2 and N3 exist differences in AJCC system,for which it is more suitable for this group of patients than JES system.According to the lymph node metastasis rates of [L1(LNR:1%~20%),L2(LNR: 21%~50%)and L3(LNR:>50%)],it could not well predict the prognosis of the patients in this group.When patients in this group were divided into N1 stage(metastasis to 1 region),N2 stage(metastasis to 2 regions)and N3 stage(metastasis to 3 regions),it could not well predict the prognosis of patients in this group.All in all,the AJCC staging system is still the best for us nowadays.