J Cancer 2021; 12(21):6454-6464. doi:10.7150/jca.61994

Research Paper

Optimal Size Criterion for Malignant Lymph Nodes and a Novel Lymph Node Clinical Staging System for Unresectable Esophageal Squamous Cell Carcinoma: Evaluation by Multislice Spiral Computed Tomography

Hang Wang1,2#, Zheng Lin1,3,4#, Yimin Lin1,5#, Ruigang Huang6, Moliang Qiu7, Xiane Peng1,3,4, Fei He1,3,4, Liping Huang1, Zhisheng Xiang1, Wanting Lu1, Siyou Yan1, Shuang Liu1, Huimin Yang1, Zhihui Zhang1, Zhijian Hu1,3,4✉

1. Department of Epidemiology and Health Statistics, Fujian Provincial Key Laboratory of Environment factors and Cancer, School of Public Health, Fujian Medical University, Fuzhou, 350108, China.
2. Department of Disease Prevention and Healthcare, Fujian Provincial Hospital South Branch & Fujian Provincial Jinshan Hospital, Fuzhou, 350001, China.
3. Key Laboratory of Ministry of Education for Gastrointestinal Cancer, Fujian Medical University, Fuzhou, 350108, China.
4. Fujian Digital Institute of Tumor Big Data, Fujian Medical University, Fuzhou, 350122, China.
5. Fujian Center for ADR monitoring, Fujian Food and Drug Administration, Fuzhou, 350003, China.
6. Department of Imaging, Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou, 363000, China.
7. Department of Imaging, Affiliated Fuzhou First Hospital of Fujian Medical University, Fuzhou, 350009, China.
#These authors contributed equally to this work.

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Citation:
Wang H, Lin Z, Lin Y, Huang R, Qiu M, Peng X, He F, Huang L, Xiang Z, Lu W, Yan S, Liu S, Yang H, Zhang Z, Hu Z. Optimal Size Criterion for Malignant Lymph Nodes and a Novel Lymph Node Clinical Staging System for Unresectable Esophageal Squamous Cell Carcinoma: Evaluation by Multislice Spiral Computed Tomography. J Cancer 2021; 12(21):6454-6464. doi:10.7150/jca.61994. Available from https://www.jcancer.org/v12p6454.htm

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Abstract

Objectives: The current Chinese draft nodal clinical staging system for unresectable esophageal cancer is controversial. Our study aimed to propose a new diagnostic criterion for lymph node metastasis (LNM) detected by multislice spiral computed tomography (MSCT) in nonsurgically treated esophageal squamous cell carcinoma (ESCC) patients and then develop a novel lymph node (LN) clinical staging system for better individual prognostic prediction.

Methods: The short-axis diameters of regional LNs were measured in 393 nonsurgical patients. Regional nodes were considered positive for malignancy if the nodal size exceeded the optimal size, which was determined by Kaplan-Meier survival analysis. The novel LN clinical staging system was then constructed using the LASSO model based on the relative prognostic importance of different LN stations. Validation cohort was included to confirm the prognostic performance.

Results: Regional nodes were considered positive for malignancy if they were larger than 10 mm in the low cervical and upper thoracic segments, 7 mm in the middle thoracic segment, and 8 mm in the lower thoracic and celiac segments. Using the LASSO model, stations 2R, 3A, 7 and 16 were qualified in the model. Further analysis showed that our LN clinical staging system had better homogeneity, discriminatory ability and clinical value than the draft nodal staging system.

Conclusions: Our results show that the new diagnostic criterion may improve the diagnostic value of MSCT in metastatic LNs. The novel LN clinical staging system can stratify nonsurgically treated ESCC patients into different risk groups, providing valuable information for decision making and outcome prediction.

Keywords: lymph node metastasis, nonsurgical, prognosis, esophageal squamous cell carcinoma, multislice spiral computed tomography