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Revisiting Esophageal Lymphatic Metastasis Patterns And Simplified N-staging: An Anatomical And Embryological Perspective
Jiazhou Xiao, Xu Li.
The First Affiliated Hospital of Fujian Medical University, FuZhou, China.
BACKGROUND:Esophageal cancer, a malignancy with complex lymphatic metastasis patterns, remains a therapeutic challenge due to inconsistent global consensus on nodal (N) staging. Current systems (AJCC/UICC and JES) emphasize nodal burden but inadequately address anatomical and embryological nuances. Our study proposes a simplified N-staging framework rooted in esophageal segmentation, embryological origins, and lymphatic anatomy, supported by molecular and clinical evidence.
METHODS:Under our new N-staging classification, 150 patients with a resectable esophageal carcinoma in whom a transthoracic esophagectomy with 3-field lymphadenectomy were performed in three participating centers were included and retrospectively studied. All lymph node stations were excised and separately individually analyzed by pathological examination. The primary endpoint is the distribution of lymph node metastases. The second endpoint is the 3-years DFS of N0, N1 and N2 patients under new N-staging.
RESULTS:The study have provided a roadmap of the location of lymph node metastases under our new N-staging classification and 3-year DFS of N0, N1 and N2 patients are 76.3%, 58.7% and 33.6%.
CONCLUSIONS:The study have provided a roadmap of the location of lymph node metastases under our new N-staging classification and 3-year DFS of N0, N1 and N2 patients are 76.3%, 58.7% and 33.6%.Legend:A: Lymph node metastasis pathways and corresponding lymph node staging in esophageal cancer.B: Lymph node metastasis pathways and corresponding lymph node staging in upper esophageal cancer.C: Lymph node metastasis pathways and corresponding lymph node staging in lower esophageal cancer
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