title: Proposed modification of the seventh American Joint Committee on Cancer staging system for esophageal squamous cell carcinoma in Chinese patients.
abstract: BACKGROUND
  More data are essential to test the efficacy of the American Joint Committee on Cancer (AJCC) system for staging esophageal squamous cell carcinoma (ESCC). On the basis of previous studies, we propose a modification to this system to better represent the survival characteristics of ESCC in the Chinese population.
  
  
  METHODS
  We used data from two centers to establish the generating (n = 1006) and validation (n = 783) cohorts. All of the patients underwent curative surgical treatment. On the basis of previous studies, we excluded tumor location as a variable in the modified pathological staging system and defined the modified nodal categories as follows: N0, node negative; N1, 1 positive node; N2, 2 to 3 positive nodes; and N3, >3 positive nodes. The pathological T categories, pathological M categories, and cell differentiation in the seventh AJCC staging system for adenocarcinoma were used in the modified pathological staging system for ESCC.
  
  
  RESULTS
  The median survival times for ESCC patients with stage 0 and Ia, stage Ib, stage IIa, stage IIb, stage IIIa, stage IIIb, stage IIIc were as follows: not reached, 221.2, 151.8, 88.5, 25.0, 19.0, and 13.0 months, respectively, for the entire cohort of patients (n = 1789). The corresponding 5-year survival rates were 86.7, 76.4, 64.9, 55.3, 29.9, 16.9, and 9.7 %, respectively. The survival rates significantly differed between the modified staging groups (p < 0.01).
  
  
  CONCLUSIONS
  This modified staging system better discriminates the survival differences between stages than the seventh edition of the AJCC staging system for ESCC in Chinese patients.
authors.affiliation: Department of Medical Oncology, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, People's Republic of China.
authors.forename: Xue
authors.initials: X
authors.lastname: Hou
authors.forename: Jin-Chang
authors.initials: JC
authors.lastname: Wei
authors.forename: Jian-Hua
authors.initials: JH
authors.lastname: Fu
authors.forename: Xin
authors.initials: X
authors.lastname: Wang
authors.forename: Lan-Jun
authors.initials: LJ
authors.lastname: Zhang
authors.forename: Peng
authors.initials: P
authors.lastname: Lin
authors.forename: Hao-Xian
authors.initials: HX
authors.lastname: Yang
mesh_terms: D000230:Adenocarcinoma / Q000145:classification / Q000473:pathology / Q000601:surgery; D002294:Carcinoma, Squamous Cell / Q000145:classification* / Q000401:mortality / Q000473:pathology* / Q000601:surgery; D002681:China; D015331:Cohort Studies; D004938:Esophageal Neoplasms / Q000145:classification* / Q000401:mortality / Q000473:pathology* / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging / Q000379:methods / Q000592:standards*; D011379:Prognosis; D012955:Societies, Medical; D015996:Survival Rate