title: Lymph node ratio-based staging system as an alternative to the current TNM staging system to assess outcome in adenocarcinoma of the esophagogastric junction after surgical resection.
abstract: This study aimed to assess the prognostic value of the hypothetical tumor-N-ratio (rN)-metastasis (TrNM) staging system in adenocarcinoma of the esophagogastric junction (AEG). The clinical data of 387 AEG patients who received surgical resection were retrospectively reviewed. The optimal cut-off point of rN was calculated by the best cut-off approach using log-rank test. Kaplan-Meier plots and Cox regressions model were applied for univariate and multivariate survival analyses. A TrNM staging system based on rN was proposed. The discriminating ability of each staging was evaluated by using an adjusted hazard ratio (HR) and a -2log likelihood. The prediction accuracy of the model was assessed by using the area under the curve (AUC) and the Harrell's C-index. The number of examined lymph nodes (LNs) was correlated with metastatic LNs (r = 0.322, P < 0.001) but not with rN (r = 0.098, P > 0.05). The optimal cut-points of rN were calculated as 0, 0~0.3, 0.3~0.6, and 0.6~1.0. Univariate analysis revealed that pN and rN classifications significantly influenced patients' RFS and OS (P < 0.001). Multivariate analysis adjusted for significant factors revealed that rN was recognized as an independent risk factor. A larger HR, a smaller -2log likelihood and a larger prediction accuracy were obtained for rN and the modified TrNM staging system. Taken together, our study demonstrates that the proposed N-ratio-based TrNM staging system is more reliable than the TNM staging system in evaluating prognosis of AEG patients after curative resection.
authors: Department of Esophageal Cancer, Tianjin Medical University, Cancer Institute and Hospital, Key Laboratory of Cancer Prevention and Therapy of Tianjin City, Tianjin, China.
authors: Hongdian
authors: H
authors: Zhang
authors: Department of Esophageal Cancer, Tianjin Medical University, Cancer Institute and Hospital, Key Laboratory of Cancer Prevention and Therapy of Tianjin City, Tianjin, China.
authors: Xiaobin
authors: X
authors: Shang
authors: Department of Esophageal Cancer, Tianjin Medical University, Cancer Institute and Hospital, Key Laboratory of Cancer Prevention and Therapy of Tianjin City, Tianjin, China.
authors: Chuangui
authors: C
authors: Chen
authors: Department of Cardiopulmonary Function, Tianjin Medical University, Cancer Institute and Hospital, Key Laboratory of Cancer Prevention and Therapy of Tianjin City, Tianjin, China.
authors: Yongyin
authors: Y
authors: Gao
authors: Department of General Surgery, Weifang People's Hospital, Shandong, China.
authors: Xiangming
authors: X
authors: Xiao
authors: Department of Esophageal Cancer, Tianjin Medical University, Cancer Institute and Hospital, Key Laboratory of Cancer Prevention and Therapy of Tianjin City, Tianjin, China.
authors: Peng
authors: P
authors: Tang
authors: Department of Esophageal Cancer, Tianjin Medical University, Cancer Institute and Hospital, Key Laboratory of Cancer Prevention and Therapy of Tianjin City, Tianjin, China.
authors: Xiaofeng
authors: X
authors: Duan
authors: Department of Esophageal Cancer, Tianjin Medical University, Cancer Institute and Hospital, Key Laboratory of Cancer Prevention and Therapy of Tianjin City, Tianjin, China.
authors: Mingjian
authors: M
authors: Yang
authors: Department of Esophageal Cancer, Tianjin Medical University, Cancer Institute and Hospital, Key Laboratory of Cancer Prevention and Therapy of Tianjin City, Tianjin, China.
authors: Hongjing
authors: H
authors: Jiang
authors: Department of Esophageal Cancer, Tianjin Medical University, Cancer Institute and Hospital, Key Laboratory of Cancer Prevention and Therapy of Tianjin City, Tianjin, China.
authors: Zhentao
authors: Z
authors: Yu
mesh_terms: D000230:Adenocarcinoma / Q000473:pathology* / Q000601:surgery; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004938:Esophageal Neoplasms / Q000473:pathology*; D004943:Esophagogastric Junction / Q000473:pathology* / Q000601:surgery; D005260:Female; D006801:Humans; D008198:Lymph Nodes / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011379:Prognosis; D012307:Risk Factors; D016896:Treatment Outcome; D055815:Young Adult
keywords: adenocarcinoma of the esophagogastric junction; lymph node metastasis; metastatic lymph node ratio; prognosis; tumor-N-ratio-metastasis (TrNM) staging system