AUTHOR=Han Weiming , Deng Wei , Wang Qifeng , Ni Wenjie , Li Chen , Zhou Zongmei , Liang Jun , Chen Dongfu , Feng Qinfu , Bi Nan , Zhang Tao , Wang Xin , Deng Lei , Wang Wenqing , Liu Wenyang , Wang Jianyang , Xue Qi , Mao Yousheng , Liu Xiangyang , Fang Dekang , Li Jian , Wang Dali , Zhao Jun , Xiao Zefen 

TITLE=Applying post-neoadjuvant pathologic stage as prognostic tool in esophageal squamous cell carcinoma

JOURNAL=Frontiers in Oncology

VOLUME=Volume 12 - 2022

YEAR=2022

URL=https://www.frontiersin.org/journals/oncology/articles/10.3389/fonc.2022.998238

DOI=10.3389/fonc.2022.998238

ISSN=2234-943X

ABSTRACT=Background: It is still uncertain whether the newly released American Joint Committee on Cancer (AJCC) 8th post-neoadjuvant pathologic (yp) Tumor-Node-Metastasis (TNM) stage for esophageal carcinoma can perform well regarding patient stratification. The current study aimed to assess the prognostication ability of the 8th AJCC ypTNM staging system and attempted to explore how to facilitate the staging system for more effective evaluation of prognosis.
Materials and methods: 486 patients treated with neoadjuvant radiotherapy/chemoradiotherapy (nRT/CRT) were enrolled. ypN stage was reclassified by recursive partitioning. Prognostic performance, monotonicity, homogeneity, and discriminatory of yp and modified yp (myp) staging systems were assessed by time-dependent receiver operating characteristic (ROC), linear trend log-rank test, likelihood ratio χ2 test, Harrell’s c statistic, and Akaike information criterion (AIC).
Results: ypT, ypN stage, pathologic response were significant prognostic factors of overall survival. Survival was not discriminated well using the 8th AJCC ypN stage and ypTNM stage. Recursive partitioning reclassified mypN0-N2 as metastasis in 0, 1-2 and ≥3 regional lymph nodes. Applying ypT stage, mypN stage and pathologic response to construct myp staging system, myp stage performed better in time-dependent ROC, linear trend log-rank test, likelihood ratio χ2 test, Harrell’s c statistic, and AIC.
Conclusions: The 8th AJCC ypTNM staging system performed well in differentiating prognosis to some extent. By reclassifying ypN stage and enrolling pathologic response as a staging element, the myp staging system holds significant potential for prognostic discrimination.