Prognostic analysis of esophageal cancer in elderly patients: metastatic lymph node ratio versus 2010 AJCC classification by lymph nodes

World Journal of Surgical Oncology, Jul 2013

Background Recent studies have proposed a new prognostic factor (metastatic lymph node ratio, or MLNR) for patients with esophageal cancer (EC). However, to the best of our knowledge, there have been no studies conducted to date regarding MLNR in elderly patients. The aim of this study was to determine the prognostic value of MLNR staging compared with the 2010 American Joint Committee on Cancer (AJCC) N staging in elderly patients with EC. Methods From January 2001 to December 2009, a retrospective analysis of 132 consecutive patients older than 70 years of age with esophageal squamous cell carcinoma (ESCC) was conducted. Prognostic factors for disease-specific survival were analyzed. Receiver operating characteristic curves were also plotted to verify the accuracy of MLNR staging and N staging for survival prediction. Results The disease-specific survival rates of N0, N1, N2 and N3 patients according to the AJCC Cancer Staging Manual Seventh Edition N staging were 65.5%, 42.9%, 22.2% and 0, respectively (N0 vs N1, P = 0.017; N1 vsN2, = 0.050; N2 vs N3, P < 0.001). The disease-specific survival rates of MLNR0, MLNR1, MLNR2 and MLNR3 patients were 65.5%, 45.0%, 21.1% and 0, respectively (MLNR0 vsMLNR1, P = 0.026; MLNR1 vs MLNR2, P = 0.033; MLNR2 vs MLNR3, P = 0.015). The areas under the curve were 0.731 for the 2010 AJCC N staging and 0.737 for the MLNR staging. Conclusion MLNR is an independent predictor of survival in elderly patients with ESCC. MLNR staging predicts survival after EC similarly to the 2010 AJCC N classifications and should be considered an alternative to current N staging.

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Prognostic analysis of esophageal cancer in elderly patients: metastatic lymph node ratio versus 2010 AJCC classification by lymph nodes

World Journal of Surgical Oncology Prognostic analysis of esophageal cancer in elderly patients: metastatic lymph node ratio versus 2010 AJCC classification by lymph nodes Ji-Feng Feng 0 1 Ying Huang 2 Lu Chen 3 Qiang Zhao 0 1 0 Key Laboratory Diagnosis and Treatment Technology on Thoracic Oncology , Hangzhou, Zhejiang Province 310022 , China 1 Department of Thoracic Surgery, Zhejiang Cancer Hospital , No.38 Guangji Road, Banshan Bridge, Hangzhou 310022 , China 2 Department of Nursing, Zhejiang Cancer Hospital , Hangzhou , China 3 Department of Gynecologic Surgery, Zhejiang Cancer Hospital , Hangzhou , China Background: Recent studies have proposed a new prognostic factor (metastatic lymph node ratio, or MLNR) for patients with esophageal cancer (EC). However, to the best of our knowledge, there have been no studies conducted to date regarding MLNR in elderly patients. The aim of this study was to determine the prognostic value of MLNR staging compared with the 2010 American Joint Committee on Cancer (AJCC) N staging in elderly patients with EC. Methods: From January 2001 to December 2009, a retrospective analysis of 132 consecutive patients older than 70 years of age with esophageal squamous cell carcinoma (ESCC) was conducted. Prognostic factors for disease-specific survival were analyzed. Receiver operating characteristic curves were also plotted to verify the accuracy of MLNR staging and N staging for survival prediction. Results: The disease-specific survival rates of N0, N1, N2 and N3 patients according to the AJCC Cancer Staging Manual Seventh Edition N staging were 65.5%, 42.9%, 22.2% and 0, respectively (N0 vs N1, P = 0.017; N1 vsN2, = 0.050; N2 vs N3, P < 0.001). The disease-specific survival rates of MLNR0, MLNR1, MLNR2 and MLNR3 patients were 65.5%, 45.0%, 21.1% and 0, respectively (MLNR0 vsMLNR1, P = 0.026; MLNR1 vs MLNR2, P = 0.033; MLNR2 vs MLNR3, P = 0.015). The areas under the curve were 0.731 for the 2010 AJCC N staging and 0.737 for the MLNR staging. Conclusion: MLNR is an independent predictor of survival in elderly patients with ESCC. MLNR staging predicts survival after EC similarly to the 2010 AJCC N classifications and should be considered an alternative to current N staging. Esophageal cancer; Lymph node ratio; Overall survival; TNM classification Background Esophageal cancer (EC) is the eighth most common type of cancer worldwide. In China, EC is the fourth most common cause of mortality, with 11 deaths per 100,000 in 2005 [ 1 ]. However, esophageal squamous cell carcinoma (ESCC) accounts for most EC cases in China, in contrast to the predominance of adenocarcinoma in the Western world [ 2 ]. Although advances have occurred in multidisciplinary treatment, surgical resection remains the treatment modality of choice. One of the main determinants of survival for patients undergoing esophagectomy is nodal status. However, the best method of characterizing the extent of local lymph node metastases remains an area of controversy. Recent studies have proposed a new prognostic factor (metastatic lymph node ratio, or MLNR) for EC patients [ 3-5 ]. Controversy exists concerning the optimal cutoff points for the MLNR to predict overall survival. The different study sizes, variable inclusion criteria and, most important, unreliable statistical methods used to determine the cutoff points between groups have contributed to this controversy. However, to the best of our knowledge, there have been no studies conducted to date regarding MLNR in elderly patients with EC. The aim of this study was to determine the prognostic value of MLNR staging compared with the 2010 American Tumor size (mean ± SD, cm) Tumor location aESCC, esophageal squamous cell carcinoma; MLNR metastatic lymph node ratio; NMLN, number of metastatic lymph nodes; TLN, total lymph node. Joint Committee on Cancer (AJCC) classification system by lymph nodes in elderly patients with ESCC. Methods Patients We conducted a retrospective analysis of patients treated from January 2001 to December 2009. The sample population comprised 132 patients older than 70 years of age with ESCC who underwent curative esophagectomy in the Department of Thoracic Surgery, Zhejiang Cancer Hospital, Hangzhou, China. Patients who had received pre- and or postoperative chemotherapy and/or radiotherapy were excluded. We also excluded patients with non-ESCC and gastroesophageal junction carcinoma, as well as patients who underwent surgical exploration without curative esophagectomy. All of the above patients were followed up by posting letters or by telephone interviews. The last follow-up was on 30 November 2011. The clinicopathological and followup findings were collected and recorded in the database. All subjects gave their written informed consent to the study protocol, which was approved by the ethical committees of Zhejiang Cancer Hospital, Hangzhou, China. Surgery All patients were treated with radical resection. The standard surgical (...truncated)


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Ji-Feng Feng, Ying Huang, Lu Chen, Qiang Zhao. Prognostic analysis of esophageal cancer in elderly patients: metastatic lymph node ratio versus 2010 AJCC classification by lymph nodes, World Journal of Surgical Oncology, 2013, pp. 162, 11, DOI: 10.1186/1477-7819-11-162