Appraisal of a Revised Lymph Node Classification System for Esophageal Squamous Cell Cancer

Impact of the number of resected and involved lymph nodes on esophageal cancer survival

“…Apparently, a lower nodal ratio implies a larger safety margin in the lymphatic drainage area of the cancerous lesion and thus a higher likelihood of complete removal of potentially involved lymph nodes. Indeed, a few studies have shown that the nodal-ratio-based classification serves better than the involved-number-based classification [28,29,[35][36][37][38]. For patients with adequate nodal dissection, our results suggest that the nodal ratio provides at least the same prognostic value as the number of involved nodes.…”

“…Indeed, increasing tumor burden, as reflected by the number of positive regional lymph nodes with cancer, is associated with poorer survival. Previously, a few studies have recommended the number of involved lymph nodes as useful criteria to classify node-positive patients [6][7][8][9]12,15,[27][28][29][30][31][32][33][34]. However, as shown in Table III, no consensus has been reached regarding the number and the cutoffs for lymph node groupings.…”

The Metastatic Lymph Node Number and Ratio Are Independent Prognostic Factors in Esophageal Cancer

“…4 To stratify nodal status for better staging according to the total lymph node number, the positive lymph node number and ratio has been recommended. [2][3][4][5][6][7][8][9][10][11][12][13][14] However, most reports Figure 2 a No survival difference between patients with TLN<15 and TLN≥15 was found. Subgroup analysis revealed that the TLN had impact on neither node-negative (b, 3-year survival rate, 44.1% for TLN<15 and 58.6% for TLN≥15, p=0.090) nor node-positive patients (c, 3-year survival rate, 16.5% for TLN<15 and 23.8% for TLN≥15, p=0.413).…”

“…[2][3][4][5][6][7][8][9][10][11][12][13][14] Previous reports have recommended dividing patients into different N subgroups based on the total number of resected lymph nodes and the number and ratio of positive lymph nodes. [2][3][4][5][6][7][8][9][10][11][12][13][14] However, most of these studies were either small-scale or from a population-based database. [11][12][13][14] Furthermore, most studies included much more esophageal adenocarcinoma than esophageal squamous cell carcinoma (ESCC).…”

Prognostic significance of endoluminal ultrasound-defined disease length and tumor volume (EDTV) for patients with the diagnosis of esophageal cancer

“…High-resolution magnetic resonance imaging (MRI) may be superior in this regard [37]. The tumor node metastasis (TNM) histopathologic staging system for esophageal cancer is controversial [31,38,39], and several suggestions have been made with regard to improving the assessment of pN stage, including revision of the number, size, and location of lymph node metastasis (LNM) [38,40,41], as well as incorporation of the lymph node ratio (LNR = LNM/LN count) [31,42,43]. Contemporary optimum treatment of esophageal cancer is highly dependent on achieving as accurate a perceived radiologic stage as possible, and clinical evaluation of esophageal cancer is largely dependent on the number of lymph node metastases and the lymph node ratio, both of which have been proved highly predictive of long-term survival [43].…”